Purpose : To evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) and pulsed-spraypharmacomechanical thrombolysis (PSPMT) using urokinase for the management of insufficient hemodialysis access.Materials and Methods : Bwtween September 1996 and May 1998, 21 insufficient hemodialysis accesses were treated in16 patients (3 artificial arteriovenous fistulae, AVF ; and 13 arteriovenous graft, AVG). PTA and PSPMT wereperformed in 6 and 15 and 15 cases, respectively, and success and long-term patency rates were evaluated. Results: The overall success rate of PTA and PSPMT for insufficient hemodialysis access was 76.2%(16/21). The successrates of PTA and PSPMT were 83.3%(5/6) and 73.3%(11/15), respectively. the primary patency rates of PSPMT were69$pm$12.8% at 6 months and 38$pm$18.6% at 12 months. One of the two initially successful PTAs had been patent for 7months, and the second PTA was performed at that time due to venous stenosis. The other was patent for 15 monthsthroughout the follow-up period. Conclusion : PTA and PSPMT are effective primary methods for the treatment ofinsufficient hemodialysis access ; success and patency rates were high, and the procedures can be performedrepeatedly.