Purpose:  To compare primary patency rates of cutting balloon percutaneous transluminal angioplasty and conventional balloon percutaneous transluminal angioplasty in the treatment of different types of hemodialysis access stenosis. Patients  and  methods:   58  patients  with  different  types  of hemodialysis  access  stenosis in  whom  PTA  was indicated   were prospectively,  randomized  to have  either  conventional balloon percutaneous transluminal  angioplasty or cutting balloon percutaneous transluminal angioplasty   The  study  was  performed  at  3 medical  centers  in  Saudi  Arabia  {Al-Moosa Specialized  hospital  Al-Ahsaa,  Tabuk University,  & Saudi  German  Hospital  Riyadh).  The primary patency rates of conventional PTA group & cutting balloon PTA group were compared The patients were followed up for 15 months. Primary patency rates  for lesions were calculated with the Kaplan-Meier method according to the type of stenosis.compared  the two groups by using the log-rank test to determine statistical significance. Results:  In the cutting PTA group, 26 patients with 29 stenoses achieved clinical success. In the conventional PTA group, 25 patients with 30 stenoses achieved clinical success. In patients with graft-to vein anastomotic  stenosis, the primary patency rate was significantly higher for cutting PTA than for conventional PTA (P = .037).In patients with autogenous venous stenosis, intragraft  stenosis and arterial anastomotic  stenosis, no significant difference in the primary patency rate was noted between groups (P = .360, .371 & .921 respectively). Conclusion: Primary patency rates are significantly higher for cutting PTA in the treatment of graft-to-vein  anastomotic  stenosis, however, no significant differences in primary patency rates  exist  between  these  PTAs in  the  treatment  of autogenous  venous stenosis, intragraft stenosis, or arterial anastomotic stenosis.