Patients with chronic renal failure require long-term hemodialysis, and the establishment and maintenance of functional vascular access is a prerequisite for hemodialysis and a lifeline for patients who rely on dialysis for survival. An arteriovenous fistula is an artificial short-circuit between the arteries and veins using vascular surgery techniques to provide long-term and effective extracorporeal circulation for hemodialysis. A direct anastomosis between the radial artery and the cephalic vein in the distal forearm is the preferred long-term vascular access for dialysis patients and is referred to as the “standard endovascular fistula” or “first level vascular access”; however, in some cases, no suitable autologous vessel can be found for anastomosis in either forearm. However, in some cases, no suitable autologous vessel can be found for anastomosis in either forearm, and a replacement vessel has to be used to create a graft endovascular fistula, also known as “second level vascular access”. Graft endovascular fistulas are used to establish vascular access between distant arteries and veins by “bridging” them with other vessels. Autologous vessels are vessels harvested from other parts of the patient’s body, most commonly the saphenous vein of the lower extremity. Autologous vessels as vascular graft material have the advantages of high patency rate, low tissue reaction, less bleeding from puncture, and low cost; therefore, it is the material of choice for endovascular grafting. However, when autologous vessels are not applicable, artificial vessels should be chosen, which can also achieve better results. There are some common complications after arteriovenous fistula that are worth the attention of doctors and patients. 1. Progressive narrowing of the venous outflow tract and thrombosis caused by endothelial hyperplasia and thrombosis, which eventually leads to occlusion. Therefore, postoperative anticoagulation and antiplatelet therapy is necessary. If this happens, there are some remedies available and the patient should be seen in the hospital. We can correct this by catheter embolization, percutaneous endoluminal angioplasty, and surgical reconstruction of the fistula. 2. Infection, especially in patients with artificial vascular grafts, has a high incidence of infection, amounting to 5-20%. Infection is often accompanied by thrombosis, leading to blockage of the fistula and its disuse. Therefore, appropriate postoperative antibiotics should be given to prevent infection. Once infection occurs, the graft should be removed immediately to avoid serious consequences. 3. Graft aneurysms and pseudoaneurysms are mostly caused by repeated punctures. For the management of such cases, we suggest that smaller wall defects can be followed and observed; large defects causing significant or rapidly increasing aneurysms require local excision, suture repair, or interposition of a segment of the graft vessel.