Long-term vascular access has increased longevity for many patients with end-stage renal disease. Much of the hospitalization in this group of patients continues to be for maintenance of reliable vascular access. Thrombosis, infection, aneurysm, and stenosis lead to serious morbidity. The Hemasite angioaccess system has been introduced in an attempt to circumvent some of these problems. We reviewed our initial experience with 90 of these devices placed in 77 patients during the past 24 months. Thirty-five devices (39%) were placed under emergency conditions when the primary access site had failed, 34 (38%) were used as the initial access procedure, and simple patient convenience was the indication 21 times (23%). Twelve patients have died, with no deaths related to the device. Twenty-eight infections and 18 thromboses accounted for the failures. Fourteen thromboses were seen with the graftless device where collateral flow existed around it. One-year patency was 46% for all devices, 38% for 34 graftless devices placed in the upper arm, and 50% for the grafted model in the upper arm position. Overall patency is not comparable to other access methods yet patient acceptance is high. Placement in the upper arm offers the highest rate of success.