Abstract: A 62-year-old woman with end-stage renal disease and complete central venous occlusion secondary to multiple catheterizations. After all other vascular access options had been exhausted, a tunneled catheter was successfully placed via the middle hepatic vein under ultrasound and digital subtraction angiography guidance. The catheter maintained functional patency at the 12-month follow-up. This case underscores the importance of the judicious preservation of vascular access and demonstrates a salvage technique for managing extreme access challenges.