Interventional procedures related to dialysis access rapidly becoming one of the largest groups of frequently required interventions. Placement of tunnelled catheters (also known as PERM cath) for dialysis to fistuloplasty for occluded A-V fistulas or central venoplasty to salvage malfunctioning fistula, are frequently requested procedures which are performed with very high degree of success in large numbers. As the number of renal failure patients are swelling up requiring dialysis, many of them having diabetes as well with poor venous access, Interventional Radiologists are often requested to place a tunnelled catheter for long-term venous access. In more complicated cases, placing a tunnelled catheter at times becomes quite tricky and sometimerequires a combination of venoplasty before tunnelled catheter placement.