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Purpose: To establish a new way for long-term vascular access for dialysis patient with vascular access exhaustion. Materials and Methods: A patient with diabetes was found with edema of right arm and high venous pressure of AVF during hemodialysis. Intervention operations were performed to establish a tunneled cuffed catheterization. Results: Occlusion of innominate vein was confirmed by MDCTV. Puncture to superior vena cava was successful 0.5 cm below the lateral head of sternocleidomastoid muscle directly via the right neck area. Conclusion: Direct puncture via superior vena cava might be the last choice for catheter insertion site. choice for catheter insertion site. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]