The vascular access serves as the "lifeline" for the hemodialysis patient, but in recent years has become the "Achilles Heel" of the hemodialysis procedure. The vascular health of the vessels used to create arteriovenous accesses is paramount to vascular access maturation and successful outcomes. Vascular calcification is widely present in the vessels of chronic kidney disease (CKD) and end stage renal disease (ESRD) patients, and may also potentially impact the vascular access remodeling process. Few studies have been published to date evaluating vascular calcification as it relates to vascular access outcomes. However, an improved understanding of how vascular calcification plays a pathophysiological role in hemodialysis vascular access dysfunction may improve therapies to treat arteriovenous fistula (AVF) non-maturation and the health of the vessels prior to vascular access creation. © Timmy Lee.