Maintaining venous access and catheter patency in patients undergoing hemodialysis through the central catheter is a dire necessity. When conventional venous accesses have been exhausted, unconventional venous access techniques have become rational options to create vascular access for hemodialysis. Herein, a case with exhausted venous access, that underwent tunneled dialysis catheter insertion through subacutely occluded lower extremity central veins was described.