The straight forearm graft is an option when the radial artery at the wrist is strong, but the cephalic vein in the forearm is either small or obliterated by IVs, and where an upper arm fistula option is not expected to mature quickly. If done appropriately, the veins in the upper arm will be built up by the forearm graft, and be usable for upper arm fistulas when the forearm graft fails. The forearm graft ordinarily should not be done where a reasonable forearm fistula option exists.