Objective: Success of surgically constructed Arterio-Venous Fistula (AVF) for hemodialysisaccessd ependsoncareful patientse lection, siteselection, meticulous technique and postoperative care. This study aims to identify key steps to improve outcome and develop standard operating procedure of AVF surgery. Design: This isaprospective study to observeout come of AV F surgery. Setting: Study was doneatsingleinstitute, which isatertiarycare hospitali ncentral India. Participants:116patients of Chronic Kidney Disease(CKD)were included between September 2020 to May 2022 (21 months). Intervention:151 AVFconstructionsurgeriesweredonein116patientsfor hemodialysis access establishment. Outcome measures: Surgical findings, outcome (maturation failure and flow dysfunction)and complicati on swer enoted. Minimum follow upperiod was1month and maximum 20 months. Results:98distal AVFand53proximal AVF were made. Maturati on failurerate was 28.6%fordistal AVF and6% for proximal AVF. On table conversionrate from distal to proximal AVF was 17%. With low threshold for on table conversion failure rate wasreduceto10.4%ofdistalAVF.Complicationsnotedwerelimboedemain12.1% (n=14), skin ecchymosis in 6% (n=7), wound dehiscence in 4.3% (n=5), hematoma at woundsitein2.6%(n=3)andwoundinfectionin0.9%(n=1)patients.Brachialartery steal syndrome was observed in 1 patient. Conclusion: Predictableout come and minimal complicationso fA VF surgerycanbe achieved with a standard protocol based approach. Skill development programs for surgeons and technicians are recommended.