An upper extremity vascular access (VA) is preferred for haemodialysis, but when the central veins are occluded or all opportunities are exhausted, a lower extremity VA is necessary. Transposition of the superficial femoral vein is a durable arteriovenous fistula and should be the first choice in patients with long expected remaining lifetime. Peripheral arterial disease and heart failure are contraindications, and careful selection of the patients is mandatory. There is a risk of ischaemic steal and an even higher risk of wound complications. It is recommended, that the procedure is centralised.