Endovascular salvage offers a valuable approach to preserving autogenous arteriovenous fistulae (AVFs), the gold standard for haemodialysis access in patients with end-stage renal failure. Despite their advantages, early AVF failure remains a significant challenge, with failure rates ranging from 20–50%, commonly caused by juxta-anastomotic stenosis (JAS). This work outlines an innovative endovascular technique aimed at restoring patency and functionality in early AVF failures. The procedure is performed under regional anaesthesia in a hybrid operating suite, combining ultrasonographic and fluoroscopic imaging. Vascular access is obtained with ultrasound-guided antegrade puncture of the radial artery and retrograde puncture of the cephalic vein, followed by diagnostic fistulograms to precisely identify the stenotic segment. Recanalisation is achieved using a 0.018” wire and balloon catheters, with gentle predilation of the stenosis. The technique concludes with fistuloplasty, serial dilation to 6 mm, and the placement of a nitinol Supera stent to provide scaffolding and restore inflow. Early results suggest this method is both safe and effective, offering a practical alternative to abandoning failed AVFs. By addressing primary AVF failures endovascularly, this approach could reduce failure rates, improve patient outcomes, and optimise healthcare resources. While these findings are promising, further studies involving larger cohorts are essential to validate the long-term efficacy of this technique and establish its place in routine clinical practice. This work contributes to the growing field of endovascular solutions for vascular access challenges.