Objective To study the effect of arteriovenous fistulas at elbow and at wrist on left ventricular structure in maintenance hemodialysis patients. Methods A total of 46 maintenance hemodialysis patients during October 2007 to January 2011 were enrolled in this study. Arteriovenous fistula was created at elbow in 14 cases (elbow group), and at wrist in 32 cases (wrist group). Left ventricular ejection fraction (EF), shortening fraction (FS), left atrium internal dimension (LAD), aortic root internal dimension (AAo), left ventricular end diastolic internal dimension (LVDd), left ventricular end systolic internal dimension (LVDs), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), pump controlled blood flow (Qb)，left ventricular mass index(LVMI)，relative wall thickness (RWI) and E/A were compared between the two groups. Results LAD was lower in wrist group than in elbow group (40.59±4.72 vs 42.07±9.17, P＜0.05). There were no significant differences in FS, AAo, LVDd, LVDs, IVST, LVPWT, LVM, LVMI and Qb (P>0.05) nor in left ventricular function between the two groups (P>0.05). Conclusion The effects of the two kinds of arteriovenous fistula on left cardiac structure are similar. Elbow arteriovenous fistula does not account for the high risk factor for high output cardiac failure among maintenance hemodialysis patients. Therefore, elbow arteriovenous fistula is a reasonable alternative vascular access when wrist arteriovenous fistula is difficult to be made in maintenance hemodialysis patients.