OBJECTIVE: To explore and analyze the early and late efficacy and safety of ultrasound-guided percutaneous transluminal angioplasty (PTA) in patients with vascular stenosis of arteriovenous fistula (AVF). STUDY DESIGN: A total of 83 patients treated for maintenance hemodialysis and accompanied with vascular stenosis of AVF simultaneously were chosen for this research. They were randomly divided into observation group (n=43) and control group (n=40). We treated the control group with ultrasound-guided plain old balloon angioplasty (POBA), and the observation group with intravascular ultrasound (IVUS) PTA with high-pressure balloon. Subsequently, the surgical effect, hemodialysis before and after surgery, postoperative complications, and recurrence rate of AVF in the follow-up period were compared between the 2 groups. RESULTS: The observation group had substantially higher surgical success rate, lower numbers of intraoperative balloon dilation, and higher intraoperative balloon pressure than the control group. The inner diameter of postoperative arteriovenous vessels and the hemodialysis blood flow of the 2 groups were remarkably higher than those before operation, while the postoperative peak velocity decreased obviously as compared to before operation; the diameter of postoperative vascular stenosis and the hemodialysis blood flow in the observation group were notably higher than those in the control group, and the postoperative peak velocity was remarkably lower than that in the control group. There was no statistically significant difference in surgical complications between the 2 groups. The incidence in the observation group within 6 months and 12 months after surgery was critically lower than that in the control group. CONCLUSION: The IVUS-guided PTA has dramatic effects on AVF, and the application of high-pressure balloon has a higher success rate. Patients have apparently increased vessel diameter and hemodialysis blood flow, and lower long-term restenosis rate by the treatment, which is safe and valuable in clinical practice. (Anal Quant Cytopathol Histpathol 2021;43:560–566) © Science Printers and Publishers, Inc.