Numerous studies have shown that the native arteriovenous fistula (AVF) has better long-term outcomes than other forms of access for hemodialysis. However, complications may require challenging salvage procedures. The present review summarizes and discusses surgical solutions for AVF salvage recently proposed within the Fistula First Breakthrough Initiative. These include strategies to salvage primary failed fistulae due to early thrombotic events or lack of maturation, ischemia, venous hypertensive problems, aneurysms and infections.