The difficulties in maintaining vascular access in patients on long-term hemodialysis are well recognized. The author's experience with bovine grafts in such cases had been that late failure from sepsis or thrombosis was common, as reported in the literature by others. In May 1976 the expanded polytetrafluoroethylene (PTFE) prosthesis became the substitute of choice as a vascular graft. In the last 18 months these grafts have been placed as subcutaneous arteriovenous fistulas in 22 patients. Three early failures occurred as a result of graft thrombosis but one graft was salvaged by thrombectomy using a Fogarty catheter. Two late failures occurred, one after 3 and another after 6 months. All other grafts are functioning satisfactorily. Expanded OTFE grafts provide satisfactory vascular access for maintenance hemodialysis in selected patients and their use may prove to be the procedure of choice for hemodialysis in small children.