Background. Tunneled femoral vein dialysis catheters are used as a last resort when all other options for a permanent vascular access or thoracic central vein catheter have been exhausted. There is little published literature on the complications or outcomes of tunneled femoral catheters. Methods. Using a prospective, computerized vascular access database, we identified all tunneled femoral dialysis catheters placed at the University of Alabama at Birmingham during a five-year period. The clinical features, catheter patency, and complications in these patients were compared to those observed in a group of sex-, age-, and date-matched control patients with tunneled internal jugular vein dialysis catheters. Results. During the study period, 27 patients received a tunneled femoral dialysis catheter, accounting for 1.9% of all tunneled catheters placed. Only 7 patients (26%) were able to convert to a new permanent dialysis access. The primary catheter patency (time from placement to exchange) was substantially shorter for femoral catheters than for internal jugular dialysis catheters (median survival, 59 vs. >300 days, P < 0.0001). Infection-free survival was similar for both groups (P = 0.66). Seven patients with femoral catheters (or 26%) developed an ipsilateral deep vein thrombosis, but catheter use was possible with anticoagulation. Conclusion. Tunneled femoral dialysis catheters have a substantially shorter primary patency, but a similar risk of catheter-related bacteremia, as compared with internal jugular vein catheters. An ipsilateral lower extremity deep vein thrombosis occurs commonly after placement of a femoral dialysis catheter, but does not preclude continued catheter use. © 2005 by the International Society of Nephrology.