Chronic hemodialysis requires an adequately functioning, surgically created vascular access. Many operative techniques have been devised, and each is subject to a variety of complications that significantly shorten the life span of any shunt. Among these are stenosis, thrombosis, aneurysm, pseudoaneurysm, and infection. High resolution sonography is a promising means to evaluate most of these complications. To determine the potential capability of the technique for detecting graft complications, a retrospective review of 30 hemodialysis patients examined with high resolution sonography is presented. Sonographic findings in normal grafts and in a variety of vascular access problems are illustrated.