End stage renal disease is a common problem all over the world. More than 75% of these patients require maintenance dialysis. Mortality rates are more than 20% per year with the use of dialysis , with more than half of the deaths related to vascular complications of hemodialysis . these complications include :1-Cardiovascular complications ,which are the most common , particularly myocardial infarction.2-Cerberovascular complications, mainly stroke which may be ischemic or hemorrhagic.3-Peripheral arterial occlusive disease which is the leading cause of amputation among the end stage renal disease population.4-Vascular access complications, which account for 16-25%of hospital admissions in hemodialysis patients