In the present report, we describe a two-stage technique of combined basilic and brachial vein transposition. Our patient had a brachial-basilic vein fistula created, but during the second stage for the transposition, a low basilic-brachial vein confluence was found. Instead of abandoning the procedure, the brachial vein was mobilized and transposed to primarily constitute a usable fistula, which subsequently was successfully used for hemodialysis. A detailed description of our technique is provided. Surgeons should be aware of this alternative procedure to maximize fistula creation rates.