Arteriovenous fistula (AVF) is the preferable modality of blood access for hemodialysis. However, AVF dysfunction is the main cause that limits its clinical use, in spite of the fact that perioperative management, surgical technology and prevention of primary AVF dysfunction have been greatly improved. The culprit of AVF dysfunction is neointimal hyperplasia, which is resulted from the comprehensive effects of inflammation, hypoxia and hemodynamic changes. Local treatment to provide structural and functional support for AVF and to deliver high dose of drugs directly to AVF site can be used to promote AVF maturation and to reduce the potential side effects from systemic drug therapies. This article reviews a series of local vascular treatment methods, offering new perspectives of therapies targeting AVF dysfunction.