The number of individuals undergoing maintenance hemodialysis is rapidly increasing worldwide, accompanied by a rising incidence of central venous stenosis and occlusion, particularly among patients with a history of catheterization. Single-puncture endovascular intervention is generally the preferred treatment approach. We present the case of a 49-year-old male on regular hemodialysis via a functioning right elbow arteriovenous fistula who developed complex stenosis/occlusion involving multiple central venous sites. Due to the challenging venous anatomy and failure of both single- and dual-access techniques, a quadruple-puncture approach was successfully employed to perform balloon angioplasty. This case highlights the value of a personalized and innovative endovascular strategy in managing complex central venous stenosis and occlusion, especially when conventional methods are unsuccessful.

The rising global incidence of kidney failure has increased the demand for long-term hemodialysis, which requires reliable vascular access. While arteriovenous fistulas (AVFs) are typically preferred, alternative approaches are needed when autogenous options are exhausted. The use of translocated autologous saphenous vein (SV) conduits has been predominantly documented in developed countries but rarely employed in developing nations, including Vietnam. We presented the case of a 54-year-old patient with dysfunction of all common vascular access sites and central venous catheters. This case represents the first successful use of a translocated autologous great saphenous vein to create arteriovenous access in Vietnam, with a follow-up period of 3 years. The study also highlights the potential of autologous SV conduits as a superior option for vascular access compared to prosthetic grafts. This approach is particularly crucial in developing countries, where economic constraints and the high prevalence of kidney disease often limit access to prosthetic grafts.