Introduction: The arteriovenous fistula (AVF) is the gold standard access modality for haemodialysis, but due to patient and technical factors, it is prone to stenosis and thrombosis. The trans-radial approach offers multiple unique benefits, but its safety, efficiency and efficacy have not been rigorously studied in the context of the AVF. This study provides a case series of trans-radial AVF procedures, and a systematic review and meta-analysis of existing literature to solidify the role of the trans-radial approach in endovascular AVF surgery. Methods: Surgical records were interrogated to identify all trans-radial AVF interventions between 2019-2021. The primary endpoints were procedure time and complication rates. The secondary endpoints were primary assisted patency and increase in pre- and post-operative brachial artery blood flow. The systematic review was performed by searching MEDLINE, Embase and CENTRAL from 2000-2023. Results: The case series identified 76 consecutive procedures performed on 49 patients. Mean procedure time was 64 minutes, and only one complication, a puncture site haematoma, was identified. Mean postoperative AVF flow increase was 342mL/min (p<0.001). Primary-assisted patency at 6 and 12 months was 91% and 82% respectively. The systematic review included 16 studies totalling 1163 procedures. Mean procedure time was 44 minutes. Complications were rare: procedural failure (1.2%), hematoma (0.90%), radial artery occlusion (0.74%), and pseudoaneurysm (0.12%). Post-procedural flow increased by an average of 274 mL/min. Pooled primary-assisted patency rates at 6 and 12 months were 88% and 77% respectively. Conclusion: The trans-radial approach allows for expedient, safe and durable AVF endovascular surgery, however this technique would benefit from prospective evaluation.