Surgery for hemodialysis access is the most commonly performed vascular surgical operation in the United States, predominantly because of a steady increase in the prevalence of end-stage renal disease. Multiple studies have confirmed the improved patency rate and lower infection rates for native arteriovenous fistulae compared with prosthetic arteriovenous grafts. In formulating a strategy for successful dialysis access a comprehensive approach should be undertaken. The preoperative planning, as with any surgical procedure, is the most important aspect, followed by the postoperative maintenance of the access.