Background Patients who need long‐term haemodialysis often require multiple operations to maintain their vascular access. The options for secondary or tertiary access procedures may become increasingly limited. Prosthetic conduits are commonly used in difficult cases but are associated with a high incidence of complications. Methods The brachial artery–transposed basilic vein arteriovenous fistula has been used in preference to a prosthetic graft on 31 occasions. Results There were no technical failures and 28 of these fistulas matured. No major infective complications occurred. Conclusion This procedure should be considered before resorting to a prosthetic graft for vascular access. © 1998 British Journal of Surgery Society Ltd