Av fistulas are prefered method in hemodyalytic patients with end stage renal diseases. 46 year old male a known hypertemsive on treatment for the past 10 years ,was diagnosed to have chronic renal failure 3 year ago. Consequently he was progressed to ESRD and hemodyalysis.He has been going thrice weekly regular hemodyalsis since then. Over the past year his AV fistula increase in size to attain its current dimemsion.