Vascular access still remains the “Achilles’ heel” of the dialysis process. It seems that the native arteriovenous fistula that Brescia and Cimino described in 1966 still remains the first choice vascular access, however not all patients can be fit for that procedure. According to the KDOQI and European guidelines, when the patient vessels are not fit for radial-cephalic arterio-venous fistula (RCAVF) or brachial-cephalic arterio-venous fistula (BCAVF), the next recommended option is to either construct brachial-basilic arterio-venous fistula (BBAVF) or the use of a prosthetic implant. We studied 24 patients with End Stage Renal Disease (ESRD) who have inappropriate forearm vessels to construct autogenous fistula. Patients and methods: This is a randomized controlled study which included 24 patients. Eleven patients underwent forearm loop graft (the study group) and thirteen patients underwent brachial-basilic AVF with superficialization (control group). All patients in both groups were followed up over a period of 12 months at Kasr Alainy teaching hospital from July 2015 to July 2016. Our goal was to stand on the best hemodialysis option for ESRD patients with low quality forearm vessels regarding primary and assisted primary patency rates and complications. Results: Diabetes mellitus was found in nine patients (five were in the forearm loop graft group and the other four were in the BBAVF group). Hypertension was found in thirteen patients (seven were in the forearm loop graft group and six were in BBAVF group). In the forearm loop group, postoperative oedema developed in six patients, 6/11 (54.5%). In BBAVF group, postoperative oedema developed in two patients, 2/13 (15.4%). There was statistically significant difference in the incidence of post-operative oedema between the two groups (p=0.05). There was no significant statistical difference between the two groups regarding post operative venous hypertension, hematoma, infection, pseudoaneurysm, thrombosis and stenosis. No patients developed steal syndrome or heart failure in both groups. In the forearm loop group, the primary patency rate after one year was 81.8%. In the BBAVF, the 1ry patency rate was 92.3% in the 1st 6 months whereas the assisted 1ry patency rate was 100% in the same period. By the end of the 1st year, the 1ry patency rate was 84.6% and the assisted 1ry patency rate was 100% in the same period. Conclusion: The concept of "Whenever BBAVFs fail, it is still possible to create a prosthetic graft fistula in most patients” has to be changed to become "Whenever loop forearm prosthetic graft fails, it is still possible to have a BBAVF". Key Words: Forearm Loop, Brachial-Basilic, AVF.