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dard for management of carotid stenosis in symptomatic as well as asymptomatic patients with critical stenosis. Carotid Endarterectomy is a relatively safe and effective procedure in our large series from Pakistan. It remains the standard for management of carotid stenosis in symptomatic as well as asymptomatic patients with critical stenosis. Recently, there has been an abundance of encouraging data regarding the creation of percutaneous arteriovenous fistulas. Despite promising data regarding their clinical maturation, a paucit