Laser thermal angioplasty with a sapphire hot-tip Nd-YAG laser system was effectively used for five grafts with anastomotic stenotic lesions which occurred after femoro-popliteal arterial reconstructions. Stenotic lesions were detected by a combination of Doppler flow waveform analysis and ankle/brachial index measurement in 32 femoro-popliteal and five femoro-tibial arterial bypass grafts in the postoperative period. The laser probe used was 3 to 4 mm in diameter. There were no perforations of the arterial wall caused by thermal ablation, even with repeated pulses of 40 watts of laser energy for 3 s. Contact Nd-YAG laser thermal angioplasty using this rounded, 3-4 mm hot-tip facilitated effective widening of the lumen of the anastomotic stenotic lesion. All patients remain well at follow-up from 9 to 20 months after laser thermal angioplasty.