Objective To evaluate the clinical application of snuffbox arteriovenous fistula(SAF) in maintenance hemodialysis. Methods One hundred and sixty-nine direct internal arteriovenous fistulas(DIAF) for hemodialysis patients with chronic renal failure(CRF) were established under microsurgery, 83 being at anatomical snuffbox and 86 at wrist of distal forearm(Cimino fistula, CF). The time of mature, the volume of blood flow, the patency rate of short-term and long-term, and complications in DIAF were observed. Results There were no significant differences in two groups of SAF and CF on the time of mature and the volume of blood flow ( P>0.05). The patency rates in SAF and CF were 96.4% vs 95.3% in four weeks( P>0.05), 92.6% vs 80.7% in one year ( P < 0.05), 86.7% vs 72.2% in two year ( P<0.05) and 81.4% vs 63.0% in three year ( P<0.05). The incidence rates of thrombosis in SAF and CF were 18.6% and 37.0% respectively ( P<0.05), and that of aneurysm were 14.3% and 30.1% respectively ( P<0.05). Conclusions Performing easily, having a better long-term patency rate and fewer complications, sparing the proximal vessels for reoperation if necessary, the snuffbox arteriovenous fistula is the most advisable permanent vascular access in hemodialysis. 