Arteriovenous access for long-term hemodialysis in patients with the acquired immunodeficiency syndrome (AIDS) represents a special challenge. Many of these patients are chronic intravenous drug abusers and do not have patent superficial upper-extremity veins available for conventional arteriovenous fistulas. This group of patients is also particularly prone to infections, which contraindicates the use of prosthetic grafts. Over a period of 13 months, five lower-extremity saphenous vein transposition arteriovenous fistulas (SVTAFs) were performed. Four patients had a diagnosis of AIDS at the time of operation; all of these were intravenous drug abusers. Three patients were male, two were female, and their age ranged from 34 to 66 years (mean, 48). Three patients had a SVTAF as their first hemodialysis access, and in two it was performed after multiple failed upper-extremity accesses. Four fistulas remain patent to date, after a mean follow-up of 11 months (range, 4 weeks to 16 months). One fistula thrombosed 4 weeks postoperatively, due to a hematoma that occurred after premature venipuncture for dialysis. There were no other major complications. We conclude that SVTAF is a suitable alternative to the limited hemodialysis venous access sites, especially in the AIDS population.