Background and aim Vascular access dysfunction is serious for hemodialysis patients. Interventional radiologist is able to salvage hemodialysis access fistulas with excellent clinical success. Patients and methods The procedures were carried out in the Interventional Radiology Unit of National Guard Hospital, Riyadh, Saudi Arabia, between January 2010 and March 2012. In total, 60 patients of vascular access dysfunction were included, who underwent diagnostic interventional angiographic procedures. Results A total of 60 patients included in study were divided into three groups: group I, which included six patients (10%) with synthetic grafts; group II, which included 15 patients (25%) with tunneled dialysis catheter; and group III, which included 39 patients (65%) with native fistulas. The angiographic success rate was lower for fistulas than for grafts (74.36 vs. 83.33%). Conclusion The catheter-based treatment of thrombosed and failing hemodialysis accesses achieves technical and clinical success in the majority of cases and allows patients to undergo immediate hemodialysis without the need for the placement of temporary dialysis catheters or surgical consumption of additional venous conduits.