Introduction & Objective: Creation and maintenance of a durable access for hemodialysis in end stage renal disease (ESRD) patients, is one of the most important interventions of vascular surgeons. Tunneled catheters, although as the last option for permanent access, are inevitable in many patients. Femoral catheters have inferior results in terms of patency and complications comparing jugular catheters based on current evidences. Materials & Methods: Thirty six ESRD patients on chronic hemodialysis were scheduled for transfemoral insertion of tunneled hemodialysis catheters as the last resort, after failure of permanent accesses and inability to insertion of catheters via cervical veins using our technique in Shohadaye Tajrish medical center. Results were recorded in terms of patency in various intervals and complications. Results: Catheter insertion was successful in all patients. Short term and long term patency rates and complication profiles were comparable to recorded results for tunneled jugular catheters, based on several studies. Life threatening complications were significantly lower than jugular catheters. Conclusions: Transfemoral catheters, if preciously inserted, can provide a durable access for hemodialysis and even can be good alternatives for jugular catheters in patients dependent to catheters for hemodialysis.