The invention provides vascular access methods, systems and devices facilitating long-term, repeated access to any of a patient's anatomical vessels and the body fluid therein, such as a patient's bloodstream. This is provided by an access tube apparatus adapted for anastomosis to a target anatomical vessel. The access tube has an occluder that fits within the conduit of the access tube when vascular access is not needed. The occluder can be selectively moved or removed to allow for access to the body fluid in the anatomical vessel by way of the access tube.