Effective monitoring and surveillance of an arteriovenous fistula are vital to preserve vascular access and ensure optimal hemodialysis results. This chapter explores both clinical monitoring, through regular physical examination, and arteriovenous fistula pressure and recirculation assessment. Concerning surveillance methods, such as access flow measurement and duplex ultrasound, emphasis is placed on the early detection of complications such as stenosis or thrombosis. Additionally, vascular access management models are discussed, highlighting multidisciplinary approaches that integrate nephrologists, surgeons, and nephrology nurses. These models promote standardized protocols, timely interventions, and continuity of care. A structured, proactive strategy improves arteriovenous fistula longevity, reduces complications, and increases overall patient safety and treatment effectiveness.