The Society for Vascular Surgery clinical practice guidelines for hemodialysis access, in accordance with the National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines and the Fistula First Breakthrough Initiative, recommend consideration of autogenous access over prosthetic conduits whenever possible. In a significant number of patients, however, upper extremity autogenous access is deemed unfeasible because of lack of a vein of suitable caliber (2 mm or less). This report describes the initial experience with a new class of autogenous hemodialysis access based on autogenous spiral vein grafts (helix fistulas).