Much attention has been devoted to the avoidance of tunneled hemodialysis catheters, in favor of arteriovenous fistulas (AVFs) or arteriovenous grafts (AVGs), in patients receiving maintenance hemodialysis, given the risk of serious infection. Less is known about the burden of interventional procedures following surgical placement of AVFs and AVGs. The challenge of initiating patients with AVFs is complicated by a primary failure rate of 30%-70% and 1-year primary patency rate of 40%-70%.1,2