Establishing and maintaining hemodialysis access are major challenges in dialysis patient care. The impact of implementing guideline recommendations around vascular access surveillance, which lacks strong evidence, is poorly understood. We report the results of a vascular access surveillance and early intervention program upon hemodialysis thrombosis rates for all patients hemodialyzing in a single center between January 2005 and March 2011. Data were derived from hospital records and the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA). Data were collected of 227 prevalent patients over the 6-year period. Crude ultrasound and angiography intervention rates increased from 23 and 57 per 100 prevalent patients per quarter (/100 pts/qtr) to 31 and 83/100 pts/qtr, respectively, during the study. Crude thrombosis rates fell from 21 to 2/100 pts/qtr during the study. After adjustment for comorbidities, mean ultrasound use increased by 4.6% per quarter (95% CI: 2.4–6.9, p < 0.001), mean interventional angiography increased by 2.6% per quarter (95% CI: 1.1–4.2, p = 0.001), and the predicted mean of the number of thromboses decreased by 8.4% per quarter (95% CI: 5.6–11.1, p < 0.001). Implementation of a vascular access surveillance increases service utilization and is associated with a reduction in vascular access thrombosis.