Abstract: Autogenous arteriovenous fistula (AVF) is the first choice access for hemodialysis treatment in patients with end-stage renal disease (ESRD), but after the establishment of AVF, there are many factors affecting its maturity rate and survival rate. The histopathological changes of their own blood vessels are important mechanisms leading to immature internal fistula, including the pre-operative pathological changes and the progression of these pathological changes after the operation, as well as the emergence of new pathological changes. Understanding of the above-mentioned vascular pathological changes can guide the targeted therapy to improve maturity rate and survival rate of arteriovenous fistula.