PURPOSE Arteriovenous fistulas (AVFs) and Arteriovenous Grafts (AVGs) for haemodialysis often develop stenoses leading to thrombosis warranting thrombectomy or alternative dialysis access, which present procedural risks to the patient and increased costs to the hospital. Ultrasound (USS) surveillance can identify features predictive of thrombosis. Our study aimed to analyse factors associated with recurrent AVF/AVG thrombosis and compare the results of endovascular and surgical thrombectomy. METHODOLOGY We reviewed all haemodialysis patients at Monash Health who presented with a thrombosed AVF in 2023-2024 and assessed the outcomes of endovascular versus surgical thrombectomy, rates of early reintervention and factors predictive of recurrent AVF/AVG thrombosis. RESULTS There were 62 AVF/AVG thrombosis events between January 2023-June 2024 for a haemodialysis population of 1744 patients. 14% of patients presenting with a thrombosed AVF/AVG initially underwent endovascular thrombectomy, which was unsuccessful in 6% requiring subsequent surgery. The remaining 86% of patients underwent initial surgical thrombectomy. The 6-month reintervention rate in those who underwent endovascular intervention was 60% compared to 33% in those who underwent surgical thrombectomy. Factors associated with early reintervention included: multiple prior interventions, presence of prosthetic and minimal outflow luminal diameter < 2.5 mm on USS (all p < 0.05). 37% of patients who presented with a thrombosed AVF/AVG had a recent USS demonstrating outflow diameter < 2.5 mm or volume flow rate < 600 mL/min. CONCLUSIONS Outflow luminal diameter < 2.5 mm and volume flow rate of < 600 mL/min were predictive of impending AVF/AVG thrombosis. Surgical thrombectomy is more durable compared to endovascular thrombectomy in the management of AVF/AVG thrombosis. A proportion of these patients’ presentations may have been preventable by timely correction of problematic stenoses detected on USS surveillance.