One of the long-term treatments for end-stage renal failure is hemodialysis. Nowadays, we have sophisticated artificial kidney devices; however, the key element of the effective usage of them is the suitable vascular access, providing a high enough volume of blood supply for the cleaning process. Methods are available from the temporary or permanent central catheterization to the creation of arterio-venous anastomoses or graft-implantation; however, the number of potential locations for vascular access and even the number of specialized vascular surgeons are limited. Thus, careful decision making is essential to choose the optimal location, the type of access, and the maintenance of it. The main diagnostic help for these processes is based on the ultrasound mapping of the blood vessels, but a careful analysis of the patient’s health condition influencing their life-span is equally important. The chapter discusses the angiological aspects of dialysis access care based on the latest recommendations.