Maintaining optimal hemodialysis vascular access (VA) in hemodialysis patients is very important to improve the patient's outcomes. Recent improvements in end-stage kidney disease (ESKD) care, changes in patient demographics, and increasing patient longevity have resulted in a renewed interest in VA management. The newly revised Kidney Disease Outcomes Quality Initiative (KDOQI) Vascular Access Guideline has many changes from the last guideline that was published in 2006. This guideline includes trials and prospective observational studies with parallel groups that compared VA interventions published from 2006 to 2016. Monitoring is the examination and evaluation of the VA to diagnose VA dysfunction using physical examination. Surveillance is the periodic examination and evaluation of the VA by using diagnostic tests that may involve special instrumentation to diagnose VA dysfunction. This presentation summarizes the monitoring and surveillance for VA flow dysfunction suggested in the new KDOQI guideline and reviews the research related to surveillance and monitoring of VA published after 2017.