Because graft patency is much worse following thrombectomy than after elective angioplasty, the current state of clinical access management involves an ongoing surveillance program to monitor for evidence of hemodynamically significant graft stenosis, and referral of such patients for elective angioplasty or surgical revision. The rationale for this approach is that correction of graft stenosis in a timely fashion will decrease the risk of graft thrombosis and prolong the survival of the graft [19]. Substantial clinical research has been directed at evaluating the predictive values of several noninvasive screening tests to identify hemodynamically significant graft stenosis, so that the patients can be referred for angioplasty or surgical revision before the graft has a chance to clot. These surveillance methods have included: dynamic dialysis venous pressures, static dialysis venous pressures, recirculation, Doppler ultrasound, ultrasound dilution methodology, and access blood flow (Reviewed in [39]). Graft stenosis can also be predicted by aggressive clinical monitoring (looking for decreases in Kt/V, prolonged bleeding at graft needle sites, and abnormalities of graft inspection and auscultation [1, 40]. A number of observational studies have reported substantial (50-60%) reductions in the frequency of graft thrombosis using a variety of surveillance methods [40-43]; none have eliminated this problem. Four randomized studies evaluating the efficacy of access surveillance on graft outcomes have found that surveillance is an excellent tool for identifying hemodynamically significant graft stenosis. However, the higher frequency of preemptive angioplasty in the surveillance group did not appear to translate into a reduction in graft thrombosis or prolongation of graft survival [44-47]. This discrepancy suggests that preemptive angioplasty may not be effective in producing sustained improvement of the stenotic lesion. Stent deployment may improve the durability of graft angioplasty and decrease the variability between operators in graft patency following radiologic interventions. Thus, it is possible that more frequent use of stents might enhance the value of graft surveillance.