PURPOSE OF REVIEW: The aim of this review will be to summarize recent concepts pertaining to the pathophysiology of dialysis access stenosis and to then use this information to highlight novel interventions (both diagnostic and therapeutic) for dialysis access dysfunction. The studies covered in this review will include experimental and observational studies in addition to clinical trials. RECENT FINDINGS: An important biological focus of this review will be an emphasis on the role of the adventitia and progenitor cells in the pathogenesis of dialysis access dysfunction. The main interventional focus will be on access surveillance, local drug delivery and other novel therapeutic interventions. An important underlying theme throughout this review will be an emphasis on arteriovenous fistulae and on the many advantages of local therapeutic interventions in the specific clinical setting of dialysis access dysfunction. SUMMARY: Vascular access dysfunction remains a significant cause of morbidity and mortality for hemodialysis patients. We believe that a better understanding of the biological mechanisms of vascular access stenosis will help guide the development of novel therapies to prevent and treat dialysis access stenosis. © 2007 Lippincott Williams & Wilkins, Inc.