Thrombolysis with recombinant tissue type plasminogen activator (t-PA) has been successfully used in occluded arteriovenous (AV) hemodialysis grafts and tunneled catheters, especially as an adjunctive regimen to invasive or semi-invasive procedures. We performed a retrospective study to evaluate the effectiveness and outcomes of thrombolysis with t-PA in occluded AV hemodialysis accesses. We used low doses of t-PA in 40 cases of thrombosed AV fistulas and grafts. Primary success was noted in 55% of the cases ensuring patency rates of 30 and 90 days at 90.9 and 69.8%, respectively. Inflammation (increased C-reactive protein concentration) and shorter functioning time of AV access were independently associated with primary outcome, whereas there was no difference in outcome between AV fistulas or grafts. No major complications were noted. We conclude that the use of t-PA is a safe and easy treatment for clotted AV accesses that can be applied in an outpatient setting.