Objective To compare the efficacy of arteriovenous fistula reconstruction and percutaneous transluminal angioplasty (PTA) balloon dilatation in the treatment of stenosis in autologous arteriovenous fistula (AVF) in elderly hemodialysis patients with hypertension. Methods A retrospective analysis was performed on the 23 elderly patients with hypertensive nephropathy who underwent AVF surgery due to hemodialysis treatment and then developed stenosis in the fistula in the Vascular Surgery Department of the People′s Hospital of Inner Mongolia Autonomous Region from February 2019 to February 2020. They were divided into 2 groups, receiving arteriovenous fistula reconstruction (control group, n=10) and PTA (study group, n=13), respectively. The general data, surgical success rate and AVF reconstruction rate in 6 months after operation were compared between the 2 groups. SPSS statistics 22.0 was used for data analysis. Data comparison between two groups was performed using student′s t test, Mann-Whitney test or Chi-square test depending on date type. Results The success rate was 80% (8/10) in the control group and 84.61% (11/13) in the study group, with no statistical difference between the two groups (P>0.05). Significant differences were observed in the reconstruction rate of AVF [61.54% (8/13) vs 40% (4/10)], size of wound [(3.10±1.76) vs (35.00±11.60) mm], operation time [(0.90±0.60) vs (1.50±0.40) h], intraoperative blood loss [10 (9,11) vs 30 (20,50) ml) and amount of contrast agent used [(50.00±25.17) and (8.13±3.34) ml] between the study group and control group (all P<0.05). Conclusion The efficacy of PTA is not inferior to arteriovenous fistula reconstruction in the treatment of AVF stenosis in elderly patients with hypertensive nephropathy, and PTA has higher revascularization rate.