AVF is the preferred hemodialysis access type because it has better patency rates and fewer complications than other access types. Surgical and endovascular management are both established treatment options for the repair of stenosis in AVFs. Endovascular management has become the first line of treatment for AVF dysfunction and replaced the surgical approach in many centers. Open surgical revision of stenotic segment within the AV access can improve both flow and function. As with all access interventions, complete fluoroscopic imaging from the arterial inflow to the right atrium is necessary, and this is generally done at the time of operative revision, and is compared with previous diagnostic imaging to determine the target lesion. Surgical revision for stenosis is generally performed using an interposition graft or a patch angioplasty. Patch angioplasty simply enlarges the area of stenosis without removing the local disease process (or consuming any available length of the vein), theoretically leading to a higher incidence of recurrent stenosis. Despite the similarities, the lesions encountered in AV access are much different from arterial lesions, typically resulting from atherosclerosis. The fibrotic, rubbery stenosis characteristic of IH do not routinely dissect, like atherosclerotic stenosis, but more commonly tear or are disrupted as a result of the obligatory higher insufflation pressures applied during balloon angioplasty. The choice for PTA or surgery for the treatment of stenosis of AVFs depends on the experience of the vascular surgeon. However, many centers around the world report an increased number of PTAs over surgery. In any case, the target of both techniques has to be 50% for primary patency during the first 6-month period.