Objective: To observe the clinical effects of color Doppler ultrasound-guided percutaneous transluminal angioplasty (PTA) and arteriovenous fistula reconstruction in the treatment of proximal stenosis of arteriovenous fistula used for hemodialysis. Methods: A total of 67 hemodialysis patients who were treated in the hospital from January 2021 to June 2024 due to proximal stenosis of arteriovenous fistula were selected. According to different surgical methods, the patients were divided into study group (n=39, color Doppler ultrasound-guided PTA) and surgery group (n=28, traditional arteriovenous fistula reconstruction). The two groups were compared in terms of ultrasound parameters of stenosed blood vessels and blood indexes before and after surgery, postoperative vascular patency rate, success rate of surgery, and the incidence of complications. Results: On day 3 after treatment, inner diameter (D), vascular area (S) and brachial artery blood flow of the study group were significantly greater than those of the surgery group (P<0.05). On day 7 after treatment, the levels of vascular endothelial growth factor A (VEGF-A) and monocyte chemoattractant protein-1 (MCP-1) in the study group were significantly lower than those in the surgery group (P<0.05). There were no statistically significant differences in postoperative vascular patency rate, technical success rate, surgical success rate, and the incidence of complications between the two groups (P>0.05). Conclusion: Color Doppler ultrasound-guided PTA is more effective and safer in the treatment of patients with proximal stenosis of arteriovenous fistula used for hemodialysis.