Objective: The purpose of this study is to evaluate the efficacy and safety of endovascular management of central venous obstruction (CVO) in chronic renal failure (CRF) patients depending on arteriovenous access. Patient and methods: We conducted our prospective study at vascular surgery department, Zagazig University Hospitals, Egypt and intervention radiology department, Alnoor Specialist Hospital, Makkah, Saudia Arabia from July 2015 to December 2018. Twenty five endovascular interventions were performed in 21 CRF patients with vascular accesses and symptomatic CVO. Two patients had radiocephalic arteriovenous fistulas, 6 patients had brachiocephalic arteriovenous fistulas and 8 patients had brachiobasilic arteriovenous fistulas and 5 patients had arteriovenous grafts. Seventeen patients (81%) reported insertion of central venous catheters. The study included 12 males and 9 females. The mean age was 51±9.5 years (range: 36-65 years). The mean duration of arteriovenous access was 10±6.5 months (range: 2-17 months). The lesions were in the distal cephalic vein in 1 patient (4.8%), axillary vein in 2 patients (9.5%), subclavian vein in 4 patients (19.1%), brachiocephalic vein in 12 patients (57.1%) and in 2 patients (9.5%) the lesions were combined. The lesions were occlusion in 12 patients (57.1%) and significant stenosis in 9 patients (42.9%). The mean lesions length was 4.5± 1.5 cm (range: 2-7 cm). Results: Technical success occurred in 17 patients (81%). Percutaneous transluminal angioplasty (PTA) was done in 12 patients and stenting was done in 5 patients. We failed in 4 patients. Early complications occurred in 3 patients (14.3%) in the form of dissection in 1 patient, and limited contrast extravasation in two patients. Late complications occurred in 5 patients (23.8%) within 4-10 months in the form of restenosis in 4 patients and thrombosis of access in 1 patient. Mean intervention-free period was 5.1 months. The primary patency rates were 70.1% at 6 months and 53.5% at 12 months and secondary patency rates were 75.3% and 63.9% at 6 and 12 months, respectively Conclusion: Endovascular management of CVO can be used safely in CRF patients with good results at the short run, but for long run results, regular follow up and re-interventions are mandatory. Decreasing insertion of central venous catheters, especially in subclavian vein, is the main prophylaxis against CVO.