Background: native AVF is the preferred form of vascular access because it is associated with the lowest rate of thrombosis and infection. When AVF blood flow is compromised, dialysis become inadequate, so the objective of vascular access survillance is the early recognition of dysfunction in order to be able to correct the stenosis by either surgery or angioplasty before access thrombosis occurs. Methods: 10 patients with 10 dysfunctional fistulas were suitable for the study. Some of them were treated using endovascular techniques and the rest were treated surgically. Conclusion: with meticulous pre-operative monitoring and periodic surveillance the chance for access dysfunction will be minimized, and even with detection of access dysfunction the option of percutanous angioplasty can play a major role hand in hand with the open surgical methods.