Introduction: Adequate venous outflow is crucial to the proper function of a vascular hemodialysis access for patients with end stage renal disease (ESRD) Stenosis or obstruction of the subclavian vein can significantly compromise this venous outflow. 
Methods: Vascular access was created in 230 patients with ESRD. Seventy-six patients had their initial AVF before dialysis, 82 had temporary subclavian catheters and 72 have been dialyzed through femoral catheters before or during the maturation of AVF. 138 patients had only one AVF that maintained adequate access for a mean duration of 38.8 months. 62 patients had two AVF with mean duration of function of 23.5 months. 
Results: Subclavian vein stenosis and obstruction developed in 25 patients. In 19 patients with subclavian vein stenosis, 
angioplasty was successful in relieving manifestations of venous hypertension whereas jumping graft was used to bypass the obstructed vein in 6 patients. 
Conclusions: 1-Venous angioplasty or bypass is a successful method to relieve venous hypertension and prolong the patency of hemodialysis access. 2- Because hemodialysis catheters in the subclavian position are associated with a high (25%) incidence of central venous stenosis or occlusion, it is wise to limit its use by the nephrologists in the initial period of patients` care.