Background: Hemodialysis in infants and young children is an effective and safe form of renal replacement therapy but problems with vascular access limit its use in the long-term. That study aimed to highlight the role of the interventional radiologist to get venous access for pediatric age group patients presented with chronic renal impairment notably cases with difficult venous access using permanent tunneled venous dialysis catheter (PermiCath). Methods: This observational study was carried out on 20 patients presented to Radiology Department at Kafr Elsheikh Main University hospital. Participants were exposed to full clinical history, previously available examinations, and radiological examination. Results: 9 cases had done AV shunt (45 %) and 11 cases were AV shunt free (55%). 15 cases were PD-free (75 %) and 5 cases were dialyzed by PD (25%). The total number of catheters inserted was 36 catheters and the number of catheters that were removed was 16 catheters. 11 catheters were removed due to mal / nonfunctioning (30.6%), 8 catheters were thrombosed (22.2 %), 2 catheters were partially slipped (5.6%), 1 catheter was removed due to fibrin sheath (2.8%). 3 catheters were removed due to catheter-related blood born infection (8.3%), and no catheters were removed from exit site infection. 2 catheters were removed electively after AV shunt working (5.6%). Conclusion: The placement of tunneled cuffed central venous catheters for hemodialysis by interventional radiologists is safe and effective with very low complication rates in children, especially with difficult venous access.