A basic understanding of the anatomy of vessels utilized to create the vascular access is crucial for proper handling and care of an access during dialysis therapy. The superficial system is most important for access creation. The superficial vein in the upper extremity that is preferred and most commonly utilized for arteriovenous fistula creation is the cephalic vein. The radiocephalic arteriovenous fistula at the wrist is the first choice hemodialysis access and utilizes the forearm segment of the cephalic vein. The brachiocephalic fistula at the elbow utilizes the upper arm segment of the cephalic vein and generally is the second choice site for arteriovenous fistula creation. The other superficial veins in the forearm (the basilic vein on the ulnar side and the median basilic vein near the elbow) are occasionally used for arteriovenous fistula creation. The deep veins in the forearm are not ideal for arteriovenous fistula creation. The deep veins in the upper arm are the brachial and basilic veins that run parallel to the brachial artery. The basilic vein in the medial aspect of the upper arm is the most common deep vein utilized for arteriovenous fistula creation. The basilic vein is mobilized from its usual location and transposed superficially through the deep fascia in the upper arm to create the “transposed basilic vein” arteriovenous fistula. The brachial veins in the upper arm are used for dialysis access as a last resort. The brachial veins and the basilic vein join and continues as subclavian vein from the outer border of the first rib and extends to the sternal end of the clavicle. A graft made from synthetic material like polytetrafluoroethylene (PTEF) is utilized for dialysis access creation if the native vessels are not suitable for creating and arteriovenous fistula. The forearm loop and upper arm straight grafts are commonly utilized configurations for creating a dialysis access. The arterial and venous system of an upper extremity including superficial and deep veins used for hemodialysis vascular access creation are discussed in this presentation with an aid of surgical photos and fluoroscopic video clips to help guide audience’ understanding.