The majority of patients with end-stage renal disease (ESRD) have anatomy suitable for arteriovenous fistula
creation. Clinical examination supplemented with duplex Doppler vessel mapping plays a crucial role in evaluation of the anatomy to plan dialysis access in a given patient. Access planning should take into consideration the overall health status and longevity of the ESRD patient on dialysis and potential for the access failure. Accordingly, access planning should involve not only a plan for the initial procedure, but include an algorithm to provide an access sequence to support the patient through the entire ESRD life.