PURPOSE: This study describes the largest reported experience to date with axillary artery-to-axillary vein or axillary artery-to-jugular vein polytetrafluoroethylene bridge fistulas for hemodialysis access. The purpose of the study was to determine the incidence of complications and the durability of the access to better determine the role of this procedure in the dialysis access algorithm. METHODS: A single center's experience over a period of 5 years was retrospectively reviewed. RESULTS: Twenty-six axillary grafts were placed in 24 patients. All but one were used for dialysis. At the time of access creation, the patients had been undergoing dialysis for a mean of 77 months (range, 5 to 256 months), had had a mean of 9.4 previous access procedures, and had exhausted all arm sites. The life-table patency rate at 3 years was 60%. The incidence of infection and thrombosis were comparable with conventional arm bridge fistulas. Neither vascular steal phenomenon nor neurologic injury occurred in this series. CONCLUSIONS: Axillary artery-to-axillary vein or axillary artery-to-jugular vein polytetrafluoroethylene bridge fistula is an excellent and durable secondary access strategy. We recommend that it be used after exhaustion of conventional arm sites.