Background Hemodialysis (HD) access failure is a common cause of increased morbidity and healthcare cost in patients with end stage renal disease (ESRD). Percutaneous balloon angioplasty has been used to treat hemodialysis access stenosis but is complicated by a high rate of restenosis. Percutaneous cutting balloon (PCB) angioplasty is an alternative approach that has shown to reduce restenosis. Objectives The aim of the study is to assess the safety and efficacy of PCB angioplasty in comparison with conventional and high‐pressure balloon angioplasty in the treatment of hemodialysis access site stenosis. Methods We searched PubMed, EMBASE and the Cochrane Central register of controlled trials (CENTRAL) databases through August 2014 and selected studies using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) checklist. We included all randomized clinical trials with a head‐to‐head comparison between PCB and conventional or high‐pressure balloon angioplasty Results Three studies with 1034 participants (age 60.7 (±12.9) years and 50.1% males) with 525 in PCB and 509 in control arm were included in the analysis. The immediate procedural success rate was not significantly different in the PCB angioplasty and control arm respectively, (87.2% vs. 83.7% RD −0.02; 95%CI −0.06 to 0.01; P = 0.38). The six‐month target lesion patency was significantly higher in the PCB angioplasty arm (67.2% vs. 55.6% RD 0.12; 95%CI 0.05–0.19; P < 0.05) with number needed to treat (NNT) of 9. The device related complications were not statistically significant between groups (RD 0.03; 95%CI −0.02 to 0.07; P = 0.26). Conclusions PCB angioplasty is effective in treatment of hemodialysis access stenosis, with significantly higher six‐month patency compared to balloon angioplasty. (J Interven Cardiol 2015;28:288–295)