End-stage renal disease leads to dependency on hemodialysis. Although the native arteriovenous fistula (AVF) is the preferred access, AVF dysfunction is a common problem. This article discusses the access circuit, diagnosis of AVF problems, and common percutaneous transluminal angioplasty techniques. Future advances to improve primary patency rates are also discussed. Knowledge of this information will aid the radiology nurse in providing quality care to this patient population.