Background Functioning dialysis vascular access is essential for end stage kidney disease patients Purpose To review the value of following a systematic DUS protocol of examination in DVA malfunction assessment. Through following this protocol, we will review the role of d-MDCTV examination in completion of DVA assessment in selected cases in which DUS assessment is incomplete. Patients and methods We evaluated 50 patients with malfunctioning DVA. The study population had been categorized into 2 groups; Group A (25 patients): was examined by DUS only, Group B (25 patients): was examined by DUS followed by d-MDCTV, using 8 channels CT scanner, with injection of 130-150 ml diluted contrast media into any accessible vein in the limb harboring dialysis vascular access Results Regarding both studied groups; different pathologies were diagnosed to cause  DVA malfunction, (anastomosis/ venous thrombosis(17), anastomosis stenosis(5), peripheral venous stenosis(9),  deep position of the VA(2), venous aneurysm/ pseudoaneurysm(8), branchouts(11), venous hypertension(5), arterial thrombosis(4), arterial stenosis(3), arterial aneurysm (4)& Dialysis induced limb ischemia(8). Diagnosis of these pathologies were almost well established by DUS alone As   regarding the evaluation of central veins for group B patients; 18 patients were confirmed by d-MDCTV to have a central venous occlusive disease; the diagnosis in 4 of them was equivocal by DUS. 7 patients were confirmed by d-MDCTV to have a normal central veins; the diagnosis in 1of them was equivocal by DUS. Conclusion A systematic DUS examination protocol is the 1st line in DVA malfunction assessment. This assessment in certain cases is incomplete. We suggest that d-MDCTV can complete this assessment.