If an autogenous wrist radiocephalic arteriovenous fistula cannot be created, the next choice for chronic hemodialysis access may be a prosthetic forearm looped arteriovenous graft (FAL-AVG) or a native upper arm arteriovenous fistula (UA-AVF). We reviewed our experience with these two forms of dialysis access to determine which is preferable. Patient medical records were retrospectively reviewed. The main outcomes were time to first use, complications, and reinterventions as well as primary and assisted primary patency. Eighty-six patients underwent creation of UA-AVF, and 60 patients underwent placement of FAL-AVG. Time to first use was 3.8 months for UA-AVFs vs. 1.8 months for FAL-AVGs (p < 0.018). Complication rates were 42% vs. 65% for UA-AVFs vs. FAL-AVGs, respectively (p = 0.006). Thrombosis was more common in FAL-AVGs than UA-AVFs (42% vs. 17%, p = 0.001), as was nonelective reintervention (50% vs. 30%, p = 0.016). Patency rates were similar at 1 and 2 years. Although UA-AVFs and FAL-AVGs share similar early patency rates, UA-AVFs may be a better choice for chronic hemodialysis access because of a lower incidence of complications and nonelective reinterventions. To maximize the benefits of UA-AVFs, however, early surgical referral is required.