Arteriovenous fistulas (AVFs) and grafts are crucial components in hemodialysis for patients suffering from end-stage renal disease. However, their high failure rate remains a consider- able challenge in medical practice, often resulting in substantial morbidity and compromised quality of life. This comprehensive review provides an in-depth examination of the potential causes behind AVF and graft failure. This includes, but is not limited to, neointimal hy- perplasia, venous hypertension, compromised flow dynamics, and infection. It additionally outlines the crucial role of patient demographics and comorbidities.Recognizing the need for efficient and effective intervention in cases of failure, this paper also reviews and compares the techniques and outcomes of balloon angioplasty and mechan- ical thrombectomy. These procedures are often necessitated by thrombosis and stenosis, significant complications leading to AVF and graft failure. Balloon angioplasty, a standard first-line therapy, is considered for its technical simplicity and relatively low invasiveness. In contrast, mechanical thrombectomy devices, which physically remove thrombi, are typically reserved for balloon angioplasty failure or larger, complex thrombi.Our review then delves into the associated risks and potential complications of these in- terventions. Notably, rethrombosis and embolization are among the significant risks, which, if not handled promptly and effectively, could lead to more severe complications and poorer patient outcomes. We present the latest statistics and analyze the risk factors contributing to rethrombosis and embolization following balloon angioplasty and mechanical thrombectomy. This review will be beneficial to medical professionals dealing with AVF and graft man- agement, offering a concise, evidence-based examination of failure etiology, therapeutic in- terventions, and their associated risks. We aim to provide a nuanced understanding of these procedures, facilitating informed decision-making in clinical practice and opening avenuesfor future research to improve patient outcomes and longevity of AVF and grafts.