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Subject must be 18 years of age or older at the time of signing and dating informed consent (no upper age limit), can be male or female.\n2. Subject who is of child bearing potential must agree to use adequate contraception for 6 months after randomization.\n3. Subject must be currently undergoing hemodialysis or anticipating the start of hemodialysis and must require a new permanent, suitable access for the AVF creation in the upper extremity.\n4. Subject must have a life expectancy of at least 26 weeks after randomization.\n5. Subject must be able to understand and be willing to complete all study requirements.\n\nExclusion Criteria:\n\n1. Subject is currently on an active organ transplant list from a deceased donor or is undergoing assessment and expects to be placed on the active organ or bone marrow transplant list within the next 26 weeks from surgery, or expects to receive a living donor organ or bone marrow within the next 26 weeks and is unwilling to change transplant list status to \"hold\" for 3 months after randomization.\n2. Subject has had more than 1 access placement surgery (defined as a new access, not a revision) in the target limb.\n3. Subject has medical conditions and diseases that may cause non-compliance with the protocol\n4. Subject has a known allergy to bovine\u002Fporcine products or collagen\u002Fgelatin products.\n5. Subject has a history of intravenous drug use within 6 months prior to screening\n6. Subject is morbidly obese, defined as having a body mass index \\>40.\n7. 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