The Fistula First Breakthrough Initiative (FFBI) shows that development of multidisciplinary teams with designated vascular access coordinators is the key to success in increasing the appropriate use of the arteriovenous fistula as access for hemodialysis. Since nephrologists should communicate expectations to surgeons regarding fistula placement and their ability to use the access repeatedly, current surgical techniques based on KDOQI guidelines and best practices are summarized in this review. These may serve also as bases for the education of the surgical community. Autogenous fistula options include primary native fistula creation in the forearm, arm and lower extremity which can be direct or based on transposed or translocated venous vessels. Optimizing autogenous options for hemodialysis requires vessel mapping and a surgeon's willingness to invest additional time and effort.