"The venous limb of the graft was accessed near its apex with a micropuncture needle. Using this access, a 6 or 7F sheath was introduced with its tip directed towards the venous outflow. A pullback venogram was performed showing patent central veins, venous anastomotic stenosis and clot in the hemodialysis conduit. Mechanical thrombectomy with the Arrow-Trerotola PTD device was performed. To remove the arterial limb clot, a second access was required. The venous limb of the graft was accessed just below the elbow with the micropuncture needle. Using this access a 6 or 7F vascular sheath was introduced with its tip directed towards the arterial limb. The arterial plug and clot in the arterial limb was removed with the PTD device. A pulse was palpable in the graft and gentle hand injection of contrast showed restoration of flow. Fistulogram shows patent arterial anastomosis, patent arterial & venous limbs (or degenration of the arterial limb with pseudoaneurysm formation or intragraft stenosis in __ limb), venous anastomosis (and/or outflow venous) stenosis, which results in greater than 50% luminal stenosis. The central veins are patent without stenosis. The venous outflow stenosis was dilated with 7mm diameter angioplasty balloon, with excellent results. Thrill was restored to the hemodialysis conduit. Vascular sheaths were removed, and hemostasis achieved by digital compression. Patient tolerated procedure well"