We suggest that a plan and protocol for eventual conversion of forearm prosthetic access to a secondary autogenous AV access should be put in place at the presence of any sign of failing forearm prosthetic AV access, or after the first failure (Grade 2, Level C).

We suggest two strategies for transitioning suitable prosthetic AV access to secondary autogenous access before abandoning a functional prosthetic access:

1. Conversion of the prosthetic access mature outflow vein to an autogenous access.
2. Identifying a new, remote site for autogenous access construction in a patient where the prosthetic access outflow vein is not deemed suitable.