Objective:To investigate the feasibility of using anastomotic stoma as a long-term vascular access to maintain hemodialysis in patients who cannot establish an effective vascular access after ACUSEAL graft occlusion.Methods:A rare case of brachial artery-right atrium ACUSEAL artificial blood vessel fistula bypass to establish vascular access occlusion, the use of artificial blood vessel anastomosis stoma to establish buttonhole puncture as a long-term vascular access and the corresponding nursing methods.Results:At present, the patients were treated with regular dialysis for 32 months and blunt needle puncture for 23 months.Conclusions:Brachial artery-right atrium ACUSEAL graft is a rare vascular access surgery. As a new type of access with depleted autologous vascular resources, the efficacy is not certain. Because it is different from the traditional vascular prosthesis surgery, once the thrombotic occlusion of the graft fails, the risk and difficulty of reopening by interventional or surgical methods are great. Therefore, it is a challenging and reasonable method to use the limited residual cavity of the anastomosis as a long-term vascular access after occlusion to prolong the service life of the graft.