[The dilemma of the last vascular access].

Age and cardio-vascular pathologies in hemodialysis patients confront us with the increasing difficulties in finding vascular access. This implies the necessity to keep in place central venous catheters (CVC) and find alternative puncturing sites. CVC malfunction in dialysis is frequently encountered (87% of cases). A variety of salvage procedures are described in the literature amongst them the "stripping" and re-canalization methods. Stripping allows withdraw fibrin strands around the CVC with a success rate of 75 to 90% and a rather low complication rate, although this may not be well documented. Re-vascularization techniques allow the placement of a CVC even across a thrombosed vessel. Success rate here is 100% in a limited series of patients. In addition to the classical access sites, like internal jugular and subclavian vein exist, alternative sites such as the external jugular, femoral or even translumbar vein.