The autologous arteriovenous fistula (AVF) is the preferred permanent vascular access for hemodialysis. However, approximately 30% to 50% of AVFs may develop dysfunction due to pathological mechanisms such as thrombosis, vascular intimal hyperplasia, and abnormal vascular remodeling. Studies have confirmed that hemodynamic abnormalities are the core driving factors behind AVF dysfunction. Following AVF surgery, local hemodynamic changes can lead to AVF maturation failure by promoting neointimal hyperplasia, inducing phenotypic transformation of endothelial cells, and driving extracellular matrix remodeling in the vascular wall. Improving surgical techniques and adopting multi-stage comprehensive intervention strategies can enhance the AVF maturation rate. And individualized design based on hemodynamic simulation technology represents an important future direction. This article provided an overview of the hemodynamic mechanisms underlying AVF dysfunction and methods to enhance the maturation rate of AVF, aiming to provide a theoretical basis for developing targeted intervention strategies to extend the service life of AVF.