Background: Objective: This study aims to evaluate the Prosthetic axillo-axillary necklace graft as a potential option for difficult dialysis access when there are no other upper limb options available. The assessment will focus on the patency durability and efficacy of this graft. Methods: We reviewed all cases of patients who came for creation an axillo-axillary arteriovenous necklace graft operation at our unit. The calculation of primary and secondary patency was performed