【Abstract】 Objective To explore a safe and effective route to apply thrombolysis drug for thrombosis in arteriovenous fistula. Methods A total of 69 cases with the blockage of arteriovenous fistula due to thrombosis were included in this study, and they were randomly assigned into two groups, control group treated with the traditional thrombolysis therapy (n=34), or test group treated with modified thrombolysis anticoagulation through puncture at thrombosis site guided by ultrasonography (n=35). Result The re-patency rate was 97.2% (34 cases) in test group, and was 58.8% (20 cases) in control group (P<0.01). The complications relating to thrombolysis such as local hemorrhages, hematoma and pain were less in test group than in control group (P<0.01). No fever, skin rashes and movement restriction in extremities occurred in both groups. Conclusion Puncture at thrombosis site guided by ultrasonography for thrombosis in arteriovenous fistula has the advantages of higher re-patency rate, less complication, and smaller dosage of urokinase used but higher localized drug concentration. Therefore, this method may have clinical application value.