**12. Conclusion**

CVD is a common occurrence in HD patients, either due to mechanical or hemodynamic factors. It could be related to catheters or AVF. It can be symptomatic or asymptomatic. Interventions will be required in symptomatic patients and in those who have VA malfunction. There are various options, and one needs to choose the modality based on the patient's need. The outcomes cannot be predicted as each vein behaves differently. Proper knowledge of anatomical lesion, pathophysiology of the lesion, patient needs, and expertise available will determine the intervention

modality and outcomes. There is a need for multidisciplinary approach to tackle the situation. We, at our institute, work with a motto which is slightly modified from the old proverb, and we proudly say that "if there's a will and a vein, there's a way." Prevention of CVS by catheter avoidance is an ideal situation; however CVD due to hemodynamic issues not related to catheters cannot be avoided, and VA surveillance is the best way for early diagnosis and management of such lesions.
