The goal of increasing arteriovenous fistula (AVF) prevalence is to provide end stage renal disease (ESRD) patients vascular access for dialysis with low morbidity and better long-term patency. This goal is realized only when a fistula matures and meets its required function. This article defines the characteristics of a well functioning AVF and the essential components required to meet these needs. The various sites that could be used for fistula creation on the basis of normal and variant anatomy are reviewed. Surgical techniques that aid early fistula maturation by reducing juxtaanastomotic problems are discussed. Postoperatively, maturation evaluation is an important component necessary for the successful use of AVF. Ultrasound vein mapping and duplex blood flow assessment provide objective data for fistula maturation evaluation. Early radiological interventions and secondary surgical procedures should be electively performed to aid maturation for fistulae that fail to achieve adequate maturation.