Background Arteriovenous fistula (AVF) remains the preferred vascular access for maintenance hemodialysis; however, real-world outcomes vary according to patient characteristics, vascular anatomy, and care pathways. Contemporary South Korean data describing patency and complication profiles after AVF creation at the institutional level remain limited. Objective To evaluate clinical outcomes, 12-month patency rates, and access-related complications following arteriovenous fistula creation for hemodialysis access in a South Korean tertiary-care center. Methods This retrospective observational study included adult patients who underwent autogenous AVF creation for hemodialysis access. Demographic, clinical, and access-related data were collected. The primary outcome was 12-month primary patency, defined as time from AVF creation to first intervention, thrombosis, or access abandonment. Secondary outcomes included assisted primary and secondary patency, maturation rate, complications, and predictors of patency loss. Patency was analyzed using the Kaplan–Meier method, and predictors were assessed using multivariable Cox proportional hazards regression. Results A total of 184 patients were included (mean age 62.4 ± 11.8 years; 60.9% male). The overall AVF maturation rate was 80.4%, and early failure occurred in 19.6%. At 12 months, primary patency was 69.6%, assisted primary patency 82.1%, and secondary patency 88.6%. Stenosis requiring intervention was the most common complication (22.8%), followed by thrombosis (11.4%). On multivariable analysis, age ≥65 years (hazard ratio [HR] 1.62), diabetes mellitus (HR 1.74), and preoperative venous diameter <2.5 mm (HR 2.09) was independently associated with loss of primary patency. Conclusions Arteriovenous fistula creation in this South Korean cohort was associated with favorable 12-month patency and acceptable complication rates. Early patency loss was predominantly influenced by patient age, diabetes, and venous anatomy. These findings support a risk-stratified, patient-centered approach to vascular access planning with emphasis on early surveillance and timely intervention to optimize AVF outcomes.

Arteriovenous fistula; Hemodialysis; Vascular access; Patency; Complications