venous cannulation and arterial catheterization have led to an increased incidence in arteriovenous fi stulae. When the adjacent artery and vein are simultaneously punctured, an abnormal connection can form. The local hemodynamic changes result in elongation and dilation of the proximal veins and the arterial circulation may be compromised distally by steal. In larger chronic fi stulas, the systemic circulation may also be affected. A thrill may be palpated over the affected site or a bruit appreciated on auscultation. The natural history is thought to be one of gradual enlarge­ment or thrombosis. Symptomatic patients require repair by open or endo­vascular techniques to restore normal perfusion and venous drainage by closing the communication. Extensive collateral circulation and friability of the artery can make the operation technically diffi cult when delayed. Therefore, most surgeons prefer to treat these cases when diagnosed. Open repairs involve either isolation of all four limbs, and quadruple ligation or ablation of the communication channel and restoration of fl ow by suture repair, patch, or interposition grafting of the two vessels. Transcatheter embolization and covered stent grafts have gained popularity particularly in surgically inaccessible areas. Endovascular interventions are particu­larly less morbid but the materials are expensive. Long-term follow-up is required to evaluate stent patency and monitor for stent migration.