Purpose: High flow associated with dialysis access arteriovenous (AV) fistulas can lead to severe complications such as high output cardiac failure, steal syndrome, and aneurysms. Various techniques have been described to treat high flow AV fistulas with varying success. This study aims to compare these operative techniques and their outcomes in a single centre. Methodology: Flow reduction procedures (banding, proximalisation of arterial inflow (PAI), revision using distal inflow (RUDI), distal revascularisation and interval ligation (DRIL), plication) performed from January 2019 to June 2024 were retrospectively reviewed. Demographics, symptoms, surgical details and outcomes were collected. Results: A total of 21 flow reduction procedures were carried out during the study period. Mean age was 56 years, with 43% of patients being women. Indications for treatment were heart failure (29%), steal (52%), aneurysmal degeneration (5%) and asymptomatic with high flow rates (15%). Surgical procedures included banding (52%), PAI (24%), DRIL (5%), RUDI (5%), and plication (14%). The average reduction in flow volume was 46% for banding and 49% for PAI. Symptom resolution was achieved in 80% for PAI and 100% for all other procedures. Fistula preservation at 6 months was 90% for banding, 80% for PAI, 100% for DRIL, RUDI and plication. Secondary re-intervention was required in 27% patients who underwent banding and 40% of patients after PAI. Indications for re-intervention were fistula thrombosis and stenosis of swing segment. Average time from flow reduction procedure to first intervention was 468 days for banding, 235 days for PAI. Conclusion: Among various options to treat high flow fistulas, banding and PAI are most commonly performed and have high success rates. Based on our results, banding demonstrates superior outcomes compared to PAI in terms of fistula preservation, need for re-intervention and mean time to re-intervention. These findings can inform clinical decisions and optimise patient outcomes.