AIM: To evaluate the effects of ultrasound-guided percutaneous transluminal angioplasty (PTA) on the arteriovenous fistula (AVF) stenosis of hemodialysis graft. MATERIALS AND METHODS: A total of 189 patients with AVF dysfunction who underwent ultrasound-guided PTA were enrolled. Their baseline data were collected. The Log-rank test, Kaplan-Meier survival analysis and univariate Cox proportional risk regression analysis were performed to compare the primary and secondary patency rates and to explore the related influencing factors. RESULTS: A total of 256 sites of stenosis were found by ultrasonography, including 80 sites in anastomotic segment, 28 in supply artery segment, 60 in drainage vein segment and 88 in proximal segment of the internal fistula vein. The mean length of stenosis was 22.4 mm, and the mean degree was 93.4%. The success rate of surgery was 96.09%, with the postoperative residual stenosis of >30% in 3.91% of patients. The clinical success rate was 97.66% and complications occurred in 2.34% of patients. The mean follow-up time was 30.2 months, and vascular patency was observed in 25.93% of patients. The primary patency rates in 1st, 2nd and 3rd years after surgery were 84.66%, 60.85% and 21.69%, respectively, and the patients with diabetes (P=0.002) and old age (P<0.001) had lower rates. The secondary patency rates in 1st, 2nd and 3rd years after surgery were 91.00%, 74.07% and 32.80%, respectively, and a lower secondary patency rate was significantly correlated with diabetes (P=0.019), old age (P<0.001), long stenosis segment (P<0.001) and high degree of residual stenosis (P=0.012). CONCLUSIONS: Vascular patency can be maintained in hemodialysis patients with AVF dysfunction through repeated intervention, and there is no need to shorten the venous segment by surgery. Ultrasound-guided PTA is a promising substitute for traditional surgery. © 2020, Edizioni Luigi Pozzi. All rights reserved.