The development of reliable vascular access has been central to the evolution of haemodialysis and the survival of patients with end-stage kidney disease. Early attempts at dialysis in the mid-twentieth century were limited by the inability to achieve repeated, durable vascular access which restricted treatment to short-term or experimental use. A major breakthrough occurred with the introduction of the external arteriovenous shunt by Belding Scribner, which enabled repeated dialysis but was associated with high rates of infection and thrombosis. These limitations prompted the search for a more durable solution, culminating in the description of the autogenous arteriovenous fistula by James Cimino and Michael Brescia. The Brescia–Cimino fistula transformed dialysis care by establishing the principles of native vessel use, long-term patency, and reduced infection risk. Subsequent decades have seen continued refinement of dialysis access, including prosthetic grafts, central venous catheters, and more recently, endovascular and hybrid techniques aimed at improving maturation and prolonging access longevity. These advances have been driven by close collaboration between vascular surgeons, nephrologists, and interventionalists. This poster traces the historical evolution of dialysis access, highlighting how surgical innovation has shaped modern practice. Looking forward, emerging technologies such as endovascular arteriovenous fistula creation, device-assisted maturation, and the growing feasibility of portable and home-based dialysis systems point toward a future of less invasive access, personalised care, and improved patient quality of life. Understanding this history underscores the enduring importance of autogenous access while informing contemporary and future decision-making in complex vascular patients.