Background: Dialysis arteriovenous (AV) fistula ruptures are rare but serious complications in end-stage renal disease (ESRD) management. They can result from various factors like high arterial pressures, repeated needle punctures, aneurysm formation, or vascular disease. Symptoms include pain, swelling, bruising, and bleeding. We hereby present a case series on the management of AV fistula ruptures. Case Series: Three cases illustrate different management approaches. Our first case was a 55-year-old woman with multiple co-morbidities underwent surgical resection of an aneurysm in her AV fistula, followed by the creation of an autologous AV fistula. Second case involved a 52-year-old woman presenting with a ruptured AV fistula aneurysm. She underwent surgical excision of the aneurysm and placement of a prosthetic graft, leading to a successful outcome. Third case was an 85-year-old man with multiple medical issues developed compartment syndrome following AV fistula rupture. Surgical intervention involved hematoma evacuation and vein repair, with subsequent improvement and preservation of vascular access. Conclusion: These cases emphasize the importance of prompt recognition and collaborative multidisciplinary intervention in managing AV fistula ruptures.