The technique of percutaneous transluminal angioplasty (PTA) has become routinely used in the management of hemodialysis access dysfunction. It is used for the management of problems that affect both AVF and grafts. In the case of fistulae, it is used for treatment of early failure caused by juxta-anastomotic stenosis and late failure related to venous stenosis. In the case of AVGs, it is used primarily for the management of venous stenosis secondary to neointimal hyperplasia. The technique has been shown to be safe, easily performed, and effective. Details of the procedure, supplies used, complications and their management, and results are reviewed in detail.