Autogenous arteriovenous fistula is a common vascular access in maintenance of hemodialysis. This paper aimed at introducing our diversified approaches in dealing with complex internal fistula, and providing new thoughts on its diagnosis and treatment. An 80- year- old male underwent fistula surgery in his left elbow. But in 1 h later, we found the noise and vibration suddenly weaken in his arteriovenous fistula. Emergency ultrasonography suggested arterial thrombosis proximal to the fistula orifice. In the second surgery, we used Forgarty catheter firstly for thrombectomy, and then stripped the atherosclerosis intima around the brachial artery fistula orifice. But we found his distal humerus pulses were decreased significantly after anastomosis, so we had to narrow the basilic vein with a piece of cardiac patch, like “wearing a ring”. After the operations, vibration was observed in the fistula orifice, and the brachial artery distal pulses were significantly strengthened. Postoperative monitoring showed that internal fistula blood flow was good. Arteriovenous fistula puncture in 6 weeks later indicated good hemodialysis efficiency, and the fistula functioned well till now, with no complications. Through this case, we hope to improve the awareness of complex fistula for the domestic physicians in order to facilitate the diagnosis and treatment of this disease.