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Harvesting of the radial artery is a common technique used to provide conduit for coronary artery bypass graft surgery. We report the case of a patient with exhausted left upper extremity access options, history of left upper extremity dialysis access-associated steal syndrome, and prior right radial artery harvest for coronary artery bypass graft who received an autogenous distal radial artery remnant to cephalic vein wrist fistula.