Abstract Background: Improving patency of hemodialysis grafts is challenging. Vascular stapling creates nonpenetrating anastomoses, possibly decreasing intimal hyperplasia. We investigated patency and flow characteristics of stapled hemodialysis grafts. Methods: Eighty-six grafts (41 stapled, 45 sewn) were placed in 84 patients (prospective, randomized). The groups had comparable demographics. Results: Thirty-six grafts were functioning at the study endpoint. Complications in both groups were similar. The primary patency (stapled, 342 days versus sewn, 382 days; P = 0.67) and secondary patency (stapled, 513 days versus sewn, 507 days; P = 0.76) had no significant differences. Flow characteristics were similar between the groups. Thrombectomies per patient-year were 1.01 for stapled grafts and 1.12 for sewn grafts (not significant). Stapling decreased the average operating time by 4.5 minutes. Conclusions: Stapled and sewn anastomoses have similar primary and secondary patency and flow characteristics, with minimal operative time differences. Stapled anastomoses are safe but had no advantage over sewn anastomoses in this study.