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Autogenous arteriovenous fistula (AVF) is the preferred option for hemodialysis access. Compared to arteriovenous grafts and hemodialysis catheters, AVFs offer improved long-term patency, reduced costs, and lower rates of infection. However, data collected in the United States from 1996 to 2001 revealed that only 24% of access procedures were AVFs. In response to unacceptably high dialysis access complication rates, the National Kidney Foundation began the Dialysis Outcomes and Quality Initiative in 1995. This prompted the formation of the National Vascular Access Improvement Initiative and the fistula first campaign. The current guidelines recommend that AVFs should be created in at least two-thirds of all hemodialysis patients in the United States.