Objective To provide the evidence for the selection of treatment methods by comparing the therapeutic efficacy and burden with patients of autologous vascular patch angioplasty and ultrasound-guided percutaneous transluminal angioplasty (PTA) in treating stenosis of autologous arteriovenous fistulas (AVF) in maintenance hemodialysis (MHD) patients. Methods Seventy patients with AVF stenosis treated at Nanchong Central Hospital's blood purification center from June 2022 to June 2023 were selected and randomly divided into an experimental group and a control group based on surgical methods. The experimental group underwent autologous vascular patch angioplasty, while the control group received ultrasound-guided PTA. The inner diameter of the stenotic site of the AVF, natural blood flow of the brachial artery, pump-controlled flow rate of hemodialysis, venous pressure, surgical complications, hospitalization costs, and primary and secondary patency rates at different time points (3 months, 6 months, and 9 months) were compared between the two groups before and after surgery. ResultsCompared with pre-surgery, the pump-controlled flow rate of hemodialysis, inner diameter of the stenotic vessel, and natural blood flow of the brachial artery significantly increased in both groups post-surgery, while venous pressure and brachial artery resistance index significantly decreased (P＜0.05).Compared with the hospitalization expenses of the control group, the hospitalization expenses of the experimental group were significantly reduced (P＜0.05). There was no bleeding in the control group, while the incidence of bleeding in the experimental group(17.14%) showed a statistically significant difference(P＜0.05); However, there was no statistically significant difference in the overall incidence of complications between the two groups (P＞0.05). The immediate technical and clinical success rates of both groups of patients after surgery were 100%; Compared with the initial patency rates at 3 months (85.71%) and 6 months (77.14%) in the control group, the experimental group had higher initial patency rates in 3 months (94.29%) and 6 months (85.71%), but there was no statistical difference(P＞0.05); The primary patency rate of the experimental group at 9 months (80.00%) was significantly higher than that of the control group (54.29%) (P＜0.05). There was no statistically significant difference (P＞0.05) in the secondary patency rates between the two groups at 3, 6, and 9 months after surgery. Within the experimental group, the secondary patency rates in at 3, 6, 9 months were increased compared to the primary patency rate, but there was no statistically significant difference (P＞0.05). In the control group, the secondary patency rate at 3 months (97.14%) was higher than its primary patency rate (85.71%), but there was no statistical difference (P＞0.05); The secondary patency rate at 6 months (94.29%) was significantly higher than its primary patency rate (77.14%) (χ2=4.200, P=0.04), and the secondary patency rate at 9 months (91.43%) was significantly higher than its primary patency rate (54.29%) (χ2=12.208, P＜0.001). Conclusion Autologous vascular patch angioplasty has a definite therapeutic effect in the application of AVF stenosis. Compared with PTA, autologous vascular patch angioplasty has a higher long-term patency rate and lower cost, making it a feasible treatment method for treating AVF stenosis