Abstract: 【Abstract】Objective To explore the creation of vascular access in hemodialysis patients whose venous resource was nearly exhausted.  Methods We studied six maintenance hemodialysis patients, who had previously undergone multiple central venous catheterizations, and were unable to create an arteriovenous fistula or graft anymore. Color Doppler ultrasound and CT angiography (CTA) confirmed multiple sites of central venous stenosis or obstruction in these patients. Percutaneous transluminal angioplasty (PTA) was performed for the stenotic or occluded brachiocephalic vein, followed by placement of indwelling central venous catheter via an internal jugular vein after successful angioplasty.  Results The catheter in one case provided a blood flow of only 180 ml/min in the second hemodialysis session, and reached 250 ml/min after being regulated the site of the catheter. The catheters in all other cases functioned well during hemodialysis (blood flow rate >250 ml/min). No catheter dysfunction or infection were discovered in any case in the following 2～6 months.  Conclusion Interventional recanalization of the stenotic or occluded central veins for the placement of indwelling hemodialysis catheter is a safe and effective method for patients whose conventional access sites have been exhausted.

Key words: Hemodialysis, Central venous catheter, Stenosis or obstruction, Interventional therapy, Vascular recanalization