Arteriovenous fistula (AVF) maturation continues to cause significant morbidity and mortality. Despite the magnitude of the clinical problem, however, there are no effective clinical or biological predictors of AVF success or failure. Caroli et al. describe an innovative technology that may be successful in predicting AVF flow and diameter using standard-of-care preoperative inputs. Pending additional longer-term validation, the use of this technology could help us get the right access into the right patient at the right time.