You will start to see a new vascular access option in your clinic. EndoAVFs are made without open surgery and often patients can recover quickly. EndoAVFs will not have a visible scar typically seen with open surgery to identify the anastomosis and more cannulation sites. You will assess an endoAVF and change needle sizes just as you would for a surgical AV fistula, but cannulation is a little different. An endoAVF feels softer and the flashback may be weaker. The outflow/ venous needle may go in a different vessel than the inflow/arterial needle. Use the rope ladder technique, and, as always, place the needles gently to avoid infiltration.