US vessel mapping for vascular access creation has evolved as standard practice in the preoperative evaluation of an ESRD patient. The best yield from this technology is when it is used to compliment physical examination and viewed in realtime by the operating physician. It is important to evaluate both arterial and venous systems during vessel mapping. While minimum diameters have been associated with an increased chance of maturation of an AV access, the quality of the vessel wall also plays an important role in maturation. US has a distinct advantage of being a noninvasive modality that can evaluate both structural and functional aspects of vessels that play an important role in access maturation.