Arteriovenous fistulas (AVFs) created for the purpose of hemodialysis are frequently lost due to various vascular lesions. Endovascular therapies with percutaneous transluminal balloon angioplasty have become very valuable in treating AVF dysfunction due to vascular stenosis. Experience with these therapies is relatively limited. In this case report, we present a patient with a severely dysfunctional AVF. The vascular lesions affecting his AVF were numerous and severe. We show how the application of aggressive endovascular treatment succeeded in restoring use of his AVF. Throughout the discussion we share observations and personal experiences that may be useful for interventionalists and health care practitioners involved with the maintenance, use, and treatment of dialysis vascular accesses.