Objective  To explore the clinical effect of bypass surgery to repair the long occlusion in the outflow tract of arteriovenous fistula (AVF).  Methods  A total of 15 cases subjected to bypass surgery to repair the long occlusion in the outflow tract of AVF in our hospital from June 2016 to June 2020 were retrospectively analyzed. Patients with a short occlusion in the outflow tract of AVF and subjected to percutaneous transluminal angioplasty (PTA) in the same period were recruited as the controls. The clinical effects were compared between the two groups.  Results  The great saphenous vein or artificial vessel was used for the bypass surgery to repair the long occlusion in the outflow tract of AVF. The successful rate of repair was 100%. Compared to the PTA group, the 2-year intervention rate was lower (P=0.032), and the 2-year patency rate was higher (P=0.046) in the bypass surgery group.  Conclusion  Bypass surgery is a safe, economical and effective method to repair the long occlusion in the outflow of AVF.