Objective:To evaluate the efficacy of a four-step massage technique assisting urokinase thrombolysis in patients with acute thrombosis of autologous arteriovenous fistula(AVF)and to preliminarily explore the therapeutic mechanism.Meth-ods:A total of 108 patients with acute thrombosis due to AVF during maintenance hemodialysis were selected as the research subjects and divided into the control group and the observation group according to different treatment methods.54 cases in the observation group were treated with urokinase thrombolysis combined with four-step manual massage,while 54 cases in the control group were given urokinase thrombolysis.The thrombolytic effect,coagulation function related indicators before and af-ter treatment,inflammation and thrombosis were compared between the two groups to evaluate the efficacy and safety.Results:The total effective rate of the observation group was higher than that of the control group(P＜0.05).The thrombolysis time in the observation group was shorter than that in the control group,the per capita dosage of urokinase was less than that in the control group,the inner diameter of the fistula and the blood flow at the internal fistula were greater than those in the control group,and the thrombolysis rate was higher than that in the control group(P＜0.05).After treatment,the activated partial prothrombin time(APTT)and prothrombin time(PT)in the observation group were longer than those in the control group.The D-dimer(D-D)was lower than that of the control group,C-reactive protein(CRP),soluble endothelial cell protein C recep-tor(sEPCR),and high mobility group protein B1(HMGB1)were lower than those in the control group(P＜0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups of patients during treatment(P＞0.05).Conclusion:The four-step massage technique combined with urokinase thrombolysis can shorten the thrombolysis time in patients with acute AVF thrombosis,reduce the amount of urokinase required,and improve efficacy.The mechanisms may involve promoting local blood circulation,reducing systemic inflammatory responses,and enhancing coagulation system functions to achieve therapeutic goals.