Today, I overheard of a patient who returned to his place of origin due to multiple central venous occlusions and multiple unsuccessful trips. The biggest problem at the end of dialysis access is vascular depletion, and depletion is manifested by the inability to place a tube, so for patients with central vein occlusion or stenosis, they should be re-tubed as early as possible, and only the superior vena cava is still present, and all can be successfully placed. Even if there is a complete occlusion between the femoral vein and the inferior vena cava bilaterally, we have a hepatic vein puncture to locate the superior vena cava and then a superior vena cava puncture to place the tube! If it is just a stenosis, then the success rate of re-tubing is quite high, and maybe after central vein treatment, we can find the opportunity to establish another internal fistula.