Background: Hemodialysis patients require reliable access for adequate dialysis, and an arteriovenous fistula (AVF) is the preferred method. The histopathology of the venous system may influence the success of AVF. This study aimed to evaluate the impact of venous histopathology on AVF outcomes in patients undergoing hemodialysis. Methods: An arteriovenous fistula was created in 107 patients with chronic kidney disease (CKD), and samples were taken from the vein during the surgical procedure. The fibrin deposition and hyperplasia of the vein wall were analyzed. The relationship between these findings and the successful function of the fistula is evaluated. Results: Structural changes such as increased vein wall thickness, fibrin deposition, and hyperplasia were identified in patients with CKD, especially in older patients. These histopathological alterations did not significantly correlate with the maturation of AVFs after 3 months of follow-up. 21 patients showing distinct fibrosis and 16 presenting with non-mature fistulas, the statistical analysis revealed no significant relationship between the histological changes observed in the vein histology and AVF maturation success (p>0.05). Conclusion: Fibrin deposition in the intima and media layers of veins has a significant relationship with age and the underlying disease of CKD. Fistula maturation after a six-month follow-up does not show a relationship with fibrosis. It is necessary to monitor the patients in the long term; probably the survival rate of the fistulas is related to the histological changes of the vein wall in the long term.