Femoral veins have been used for decades to position temporary hemodialysis catheters. Few reports, however, describe its use for permanent vascular access. This study describes the use of tunneled femoral vein catheters as permanent vascular accesses. Fourteen chronic hemodialysis patients (nine males and five females) had tunneled central venous catheters placed in the femoral vein from November 2004 to July 2005. The age of the patients ranged from 21 to 68 years with a mean of 49.8 +/- 5.9 years. Placement of a catheter via the internal jugular veins was impossible in 10 patients whose course was complicated by thrombosis or strictures of the superior vena cava. The remaining four patients had exhausted conventional access sites. The insertion of the femoral catheters involved a subcutaneous tunnel that was created by retrograde passage of the catheter through the cannula to the point of exit at a preselected site in the ipsilateral thigh away from the groin. The life span of the tunneled femoral catheter ranged between 32-240 days; median time in place was 182 days. There were four incidences of tunnel infection with Pseudomonas aeruginosa, E. coli, and Streptococcus epidermidis, which were treated successfully without the need for catheter removal. Other complications such as bleeding, kinking, migration of the catheter, arterial puncture, retroperitoneal or femoral hematomas were not observed. We conclude that tunneled femoral catheters are suitable alternatives for long-term hemodialysis access. Additional studies with a greater sample size are needed to confirm this conclusion.