The autologous arteriovenous fistula remains the best primary means of obtaining hemodialysis access. When this is unavailable, a prosthetic conduit must be considered. Selection of the appropriate access site has become increasingly important because of the increasing long-term survival of hemodialysis patients. A strategy is presented for sequential graft placement once revision at a given site is no longer feasible, with emphasis on efficient use of native arterial and venous structures, maximizing long-term patency, and preventing potential infectious and ischemic complications.