Purpose Haemodialysis patients rely on their arteriovenous fistula (AVF) as their lifeline, but there is no agreed-upon surveillance method to prevent thrombosis. In a regional area, performing routine imaging would be difficult due to resource limitations and access barriers. We investigated the incidence of AVF thrombosis in the Townsville region where patients are managed by an escalation pathway triggered by inadequate clearance, high recirculation, or clinical warning signs, without routine universal ultrasound surveillance. Methodology All patients on dialysis who had a functional AVF were identified between Jan 1, 2020 and May 1, 2024. The charts were reviewed and the following data collected: date of fistula creation, date of fistula thrombosis, date of fistula revision and operative details. Patients were placed into two groups for analysis: AVF with vein only, and AVF with graft inserted primarily or during revision surgery. Mann-Whitney U was used compare follow-up between the two groups. Results There were 212 patients with an AVF. There were 198 vein-AVF’s, and 14 graft-AVF’s. Between 2020 and 2024, there were 619.0 AVF- years of patency in the vein-AVF group with median follow up time of 3.83 years vs 45.8 years of patency in the graft-AVF group with median follow up of 0.601 years (p<0.0001). There were 16 episodes of thrombosis in the vein-AVF group vs 9 episodes in the graft-AVF group. Of the graft-AVF group, one patient experienced 4 episodes of thrombosis, two patients experienced 2 and one patient experienced 1. Sixteen patients in the vein-AVF group experienced 1. The overall thrombosis rate was 2.58% per graft-year for vein AVF vs 19.7 % for graft-AVF. Conclusion Our rate of AVF thrombosis is acceptably low. The Graft-AVF had a significantly shorter follow-up time and was associated with a higher thrombosis rate. Patients with graft-AVF may benefit from closer surveillance.