More than half a million people live in Europe on chronic renal replacement therapy by hemodialysis (HD). This number increases annually at a constant rate of 8%. The Achilles heel of HD is the vascular access (VA) used to connect patient circulation to the artificial kidney. The current recommendation for VA is the native arteriovenous fistula (AVF), surgically created in the forearm. VA dysfunction is the major cause of morbidity and hospitalisation in HD patients, and the major limitation of HD treatment. Short- and long-term AVF dysfunction includes non-maturation (inadequate increase in blood flow after surgery), stenosis due to intimal hyperplasia, and ultimately thrombotic occlusion. Steal syndrome and cardiac failure are also common complications of AVF creation. Prediction and prevention of VA dysfunction are still open clinical challenges with more than 90,000 procedures/year in Europe for revision or reoperation. Despite the magnitude of the clinical problem, there has been a paucity of novel therapeutic interventions in this field due to complex mechanisms responsible for AVF complications, which are closely related to both the sudden and sustained hemodynamic changes involved in AVF creation.The ARCH project will develop image-based patient-specific computational modelling tools to simulate hemodynamic changes induced by AVF surgery and long-term vascular and cardiac adaptation. The modelling tools will be designed and experimentally validated to predict AVF function for improvement of surgical planning and AVF management, and will be provided to clinical end users by a distributed IT infrastructure. Verification of model prediction of AVF maturation, patency, onset of steal syndrome and cardiac overload will be performed on the basis of prospective observational studies in HD patients. The basic tools and data produced in the context of the project will be made available under open-source licenses and shared in the context of the VPH initiative.