Maintenance of patent hemodialysis access is critical to prolonging the lives of patients with end-stage renal disease, and metallic stents have become a key tool for this purpose. This article discusses the primary and secondary indications for stent placement in dialysis patients, including angioplasty-induced acute venous rupture, central venous obstruction, early recurring stenosis, elastic stenosis and pseudoaneurysm. The use of stents in patients with synthetic arteriovenous grafts and native arteriovenous fistulae are discussed. With ongoing advances in stent technology as well as brachytherapy, the role of this device in the maintenance of dialysis access will likely increase. An understanding of the indications, precautions, and complications of stent deployment allows the interventional radiologist to become a principle player in the long-term care of dialysis patients.