Context: Life expectancy of end stage renal disease patients continues to lengthen and with the limited durability of vascular accesses, repeat fistula construction at different levels of the upper limb is often necessary and leads ultimately to exhaustion of autogenous vascular access sites. Our experience with alternative vascular access procedures namely the arterio-arterial loop graft in the first part of axillary artery and the permanent catheters was presented in this study. Objective: The aim of this work is to compare between the tunneled central venous catheter and the Arterio- arterial prosthetic loop (AAPL) as an access for dialysis in ESRD for whom the conventional Arterio-venous fistula is contraindicated or have no chance for the conventional methods of hemodialysis. The end point of comparison will be: reliability, safety, patency, cardiac function, postoperative flow rate, morbidity and mortality. Methodology: Prospective randomized comparative study had been conducted at vascular surgery department in Aswan university hospital on 40 patients with chronic renal failure in need for vascular access admitted. Patients are divided randomly into two groups: Group A: Includes 20 patients who had undergone Permanent catheter insertion. Group B: Includes 20 patients who had undergone Infraclavicular Arterio- arterial prosthetic loop. Results: Our findings regarding the permcath as permanent vascular access for hemodialysis ,the study group included 20 patient with survival rate 70 %,primary and secondary patency rates at 1 year was 70% and 80% respectively and the main complications encountered in the study were Thrombosis(30%), Infection (10%), Bacteremia(25%),Infective endocarditis (5%),Heart failure exacerbation(10%) and Exit site external bleeding (5%) and Taking into account that 85% of the patients were comfortable in having dialysis through the access. While regarding the Arterio-arterial group, the study included 20 patients with survival rate of 90%, primary and secondary patency rates at 1 year was 95% and the main complications encountered in the study were Thrombosis (10%), Infection (5%) and Hematoma formation (10%) and taking into account that only 55% of patients were comfortable with access and showed good compliance. Conclusion: all arteriovenous fistula/grafts options should be exhausted before hemodialysis is carried out via central venous catheters (CVC) or AALG. CVCs carry high morbidity and mortality risks than an Arterio-arterial prosthetic loop (AAPL) but patients showed better compliance to the access than the AAPL. So CVCs is indicated in patients having no chance for conventional vascular access after AAPL. Keywords: ESRD, Tunneled central venous catheter, Infraclavicular Arterio-arterial Prosthetic loop.