Background: The life expectancy of chronic renal failure patients has been prolonged. So the patient may need multiple access during his life, and exhaustion of the cephalic and basilica veins obligates the surgeon to plan for another access site. Objective: To compare the two types of access which to do first. Patients and Methods: Patients who underwent a brachial artery-brachial vein autogenous arteriovenous fistula (BVAVF) from August 2018 to August 2021were compared with those who received an arteriovenous graft (AVG) during the same period.  This study included forty end-stage chronic renal failure patients with exhausted cephalic and basilic veins who were divided into two equal groups, Group (A) with brachial artery brachial vein fistula in one stage or two stages approach, and Group (B) patients with brachial artery axillary vein polytetrafluoroethylene (PTFE) graft. Results: The mean age ± SD was 53.5±16.5 and 56.8±13 in Groups A and B respectively with a non-significant correlation. In Group (A), one case needed surgical repair of an aneurysm after two months, one case needed surgical repair of a pseudo aneurysm after eight months, and one case needed venoplasty of an innominate lesion after seven months. So, the primary assisted patency was 40% after eighteen months. In Group (B), two cases suffered from thrombectomy of the graft one after fourteen months and the other after eight months, one case suffered from venoplasty of an innominate lesion after seven months while one case needed surgical repair of pseudoaneurysm. So, the primary assisted patency in Group (B) was 70% after eighteen months. Conclusion: AVG has a higher primary patency and assisted primary patency than BVAVF but this needs more randomized trials to confirm.