Objective  To explore the ultrasound guided percutaneous balloon dilatation applied to the treatment of arteriovenous internal fistula (AVF) stenosis for blood access.  Methods  A total of 82 patients with AVF stenosis treated with surgical intervention in Xishui County Traditional Chinese Medicine Hospital of Huanggang City during January 2018 to September 2022 were enrolled in this study. They were randomly divided into experiment group and control group based on the order of case number. Ultrasound guided percutaneous balloon dilatation was performed in the experiment group, and percutaneous thrombectomy was used for the control group. Patent of the AVF, restenosis of the AVF, complication of the surgical intervention and related clinical indicators were compared between the two groups.  Results  In the experiment group, patent rates of the AVF were 90.24%, 85.36% and 80.47% after the operation for 3 months, 6 months and 12 months respectively, higher than those in the control group (χ2=3.998, 4.232 and 4.661 respectively; P=0.046, 0.040 and 0.031 respectively); restenosis rates of the AVF were 2.44%, 7.32% and 14.63% after the operation for 3 months, 6 months and 12 months respectively, lower than those in the control group (χ2=3.905, 4.479 and 5.185 respectively; P=0.048, 0.034 and 0.023 respectively); complication rate of the intervention was 2.44%, lower than that in the control group (χ2=3.905, P=0.048); after ultrasound guided percutaneous balloon dilatation intervention, the internal diameter at the previous stenosis site, blood access volume and blood flow were greater than those in the control group (t=12.425, 5.391 and 7.875 respectively; P＜0.001).  Conclusion  Ultrasound guided percutaneous balloon dilatation for the treatment of AVF stenosis and occlusion has the advantages of higher success and safety rates, real-time to display the patency and multi-angle images, and disappearance of AVF tremor after the intervention. Therefore, this method is worth to be widely used clinically.