Central  venous  stenosis  (CVS)  is a common  and significant problem in the long-term management of the hemodialysis access. The aim of this work was to study the efficacy and safety of endovascular management of central venous stenosis in relieving patient's symptoms and maintaining fUnctioning native shunt in end stage renal disease patients on hemodialysis. Balloon angioplasty (PTA) with or without stent were performed for 42 patients who had chronic renal failure and venous hypertension due to CVS. The studied group was 28 males and 14 females, mean age 45 years with 30 brachiocephalic and 12 basilic vein supeificialization. Our patients  had 3 SVC, 5 innominate, 34 subclavian vein stenosis.  PTA alone was technically successfUl in 27 (64.3%) of 42 cases. Primary stents were placed in the remaining 15 (35.7%). All procedures were technically successfUl with no major complications. Primary patency rate were 85%, 67% and 44% at 3, 6 and 12 months respectively. 28 patients needed reintervention within the 1st year of follow-up.All patients with repeated dilatation had no major complications. In conclusion, Endovascular management of central venous stenosis is an effective and safe alternative to surgery. Follow-up  and repeated  dilatations are indicated  to relieve  patient symptoms and extend  the life  of the proximal  native  A-V shunt  in hemodialysis patients