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A coming of age for vascular access research: the good, the bad, and the ugly! Dialysis vascular access dysfunction remains an important clinical problem with a very significant morbidity, mortality, and socio-economic cost. Despite the magnitude of the clinical problem, there are currently no truly effective therapies for vascular access dysfunction. Through a high-quality scientific investigation, Liang et al. have identified a number of novel biological pathways responsible for "mouse" arteriovenous fistula stenosis. We hope that the identification of these druggable pathways (targets) will allow for the development of new and effective therapies for vascular access dysfunction, through the creation of an innovation substrate for dialysis vascular access.