A patient who has impending kidney failure will need to either have a kidney transplant or be started on dialysis. A kidney specialist (nephrologist) determines a patient’s need for dialysis and may recommend that he/she will need dialysis access. Our team strictly adheres to the DOQI criteria and uses a “fistula first” strategy. All patients undergo pre-operative vein mapping or venography. Dialysis access is tailored to the individual patient to provide each patient with the most durable hemodialysis access. An arteriovenous fistula (AVF) can be created by connecting one of the native veins to an artery. For patients who do not have adequate veins, a prosthetic graft is used to create an arteriovenous graft (AVG).