BACKGROUND: Hemodialysis access sites can be complicated by both true and false aneurysms with significant potential morbidity. Aneurysms have traditionally been treated by a variety of surgical methods. Less commonly, endovascular treatment with stent graft placement has been used as an alternative to open surgery. METHODS: Four patients with symptomatic aneurysmal disease in the hemodialysis access site were treated. All patients had stent grafts (SGs) placed across the diseased segment. Once the diseased segment was excluded, blood was drained from the aneurysm with an 18 g needle. All patients were seen in clinic at 1- and 3-months post procedure. RESULTS: All patients were able to receive adequate hemodialysis post procedure. Two patients were cannulated via the SG after 1 month. No aneurysm refilling was seen. No SG infections or fractures were seen. CONCLUSION: A novel addition to the endovascular treatment of aneurysmal disease in hemodialysis patients is described, that both excludes the aneurysm and drains it, providing improvement in the aesthetic appearance of the access site.