Abstract: Objective  To observe the efficacy of preoperative contrast-enhanced ultrasound combined with intraoperative ultrasound-guided percutaneous transluminal angioplasty (PTA) in treating autologous arteriovenous fistula (AVF) stenosis.  Methods  A retrospective analysis was conducted on the data of 98 patients with AVF stenosis admitted to Baoding Second Hospital from August 2022 to January 2024. They were separated into an ultrasound group (n=47, performing PTA under ultrasound guidance) and an contrast-enhanced ultrasound group (n=51, performing preoperative contrast-enhanced ultrasound combined with intraoperative ultrasound guided PTA). After 1:1 propensity score matching (PSM), 30 cases in the ultrasound group and 30 cases in the contrast-enhanced ultrasound group were included in the study. Surgical outcomes, ultrasound parameters, postoperative complications, and restenosis rate were compared between the two groups.  Results  Compared with the ultrasound group, the contrast-enhanced ultrasound group had a shorter surgical duration (t=2.315, P=0.020) and a higher one-time success rate (χ2=5.192, P=0.023). After surgery, the degree of internal fistula stenosis was lower than before surgery in both groups (t=98.505 and 87.315, P<0.001), the degree of internal fistula stenosis in the contrast-enhanced ultrasound group was lower than that in the ultrasound group (t=3.715, P<0.001). After surgery, the inner diameter of stenosis site and brachial artery blood flow were higher than those before surgery in both groups (t=29.061, 31.852; 57.226 and 52.369 respectively; P<0.001), and the two indices in the contrast-enhanced ultrasound group were higher than those in the ultrasound group (t=2.481, P=0.016; t=3.698, P<0.001). After the operation for 6 months, the brachial artery blood flow in the contrast-enhanced ultrasound group was greater than that in the ultrasound group (t=5.623, P<0.001). There were no significant differences in the incidence of postoperative complications and restenosis between the two groups (χ2=0.417, P=0.519; χ2=0.647, P=0.421).  Conclusion  The use of preoperative contrast-enhanced ultrasound combined with intraoperative ultrasound-guided PTA can better improve the surgical efficacy of AVF stenosis, the degree of stenosis,  and the blood flow in AVF.

Key words: Contrast enhanced ultrasound, Ultrasound guidance, Percutaneous transluminal angioplasty, Autologous arteriovenous fistula stenosis