Vascular access is the primary lifeline for patients with end-stage renal disease. While arteriovenous fistulas and grafts are the conventionally favored methods for dialysis therapy, certain patients may deplete these traditional vascular access options due to various reasons. In the quest for alternatives, unconventional vascular pathways could be considered, including transhepatic, trans-lumbar and trans-renal approaches. We present a case of a 61-year-old male who exhausted all the traditional vascular access options, therefore trans-renal hemodialysis catheter placement was performed. Overall, this case highlights the challenges of securing a reliable vascular access to perform dialysis therapy and implementing unconventional methods whenever regular means are exhausted.