Formation of true and false aneurysms in vascular access for hemodialysis is a complication associated with an immediate or chronic threat to the patient, which jeopardizes access function for further dialysis. Although open surgical repair remains the established treatment of choice, during the last decade, endovascular procedures, largely utilizing stent grafts, have emerged as a viable option for treatment in emergencies as well as for elective cases. Here, basic concepts in vascular access aneurysm management are recapitulated and strategies for endovascular treatment of these complications discussed.