PURPOSE: To evaluate the effectiveness of percutaneous mechanical declotting in thrombosed dialysis graft. MATERIALS AND METHODS: Thirty-two patients with thrombosed dialysis graft in 260 cases involving insufficient hemodialytic access underwent mechanical declotting. Using a 7-F Desilets-Hoffman sheath and the crossed-catheter technique, we aspirated the intragraft clot and pushed the residual clot into the central circulation with balloon catheters. The success rate, procedure time, complications and patency rates were evaluated. RESULTS: Technical success was achieved in 24 of 32 cases, with a procedure time of 30 -240 (average, 111) minutes. In five of eight cases in which technical failure occurred, the guide wire failed to reach the stenotic site and in the other three, there was insufficient luminal dilatation. Complications included vein ruptures (n=2), arterial emboli (n=1) and arterial dissection (1), but there was no evidence of clinical symptoms of pulmonary embolism. The six-month patency rate was 67.8%. CONCLUSION: Mechanical declotting of thrombosed dialysis graft using a balloon catheter is relatively inexpensive, safe and fast, and is well tolerated.