Efficacy study of juxta-anastomotic stenosis of the arteriovenous fistula via percutaneous transluminal angioplasty with different accesses to the arteries and veins.

OBJECTIVE: Juxta-anastomotic stenosis is a leading cause of dysfunction in arteriovenous fistulas (AVFs) for hemodialysis. Percutaneous transluminal angioplasty (PTA) is the primary treatment, but the optimal access approach remains unclear. This study compared the efficacy of arterial versus venous access PTA for treating juxta-anastomotic AVF stenosis and identified risk factors for post-PTA patency loss. METHODS: This retrospective study analyzed 267 patients who underwent PTA for AVF stenosis. Patients were divided into vein and artery groups based on access route. The study compared primary patency rates, intervention interval times, restenosis rates, and postoperative complications between the two groups. Factors affecting AVF patency were analyzed by Cox regression analysis and Kaplan-Meier curves. Subgroup analysis was used to evaluate the variations in the relationships between relevant variables and patency under different access route baselines. RESULTS: Compared with venous access, arterial access PTA demonstrated superior primary patency, with 6-month rates of 76.6% vs. 46.0% (p < 0.001). The arterial group had lower restenosis (23.4% vs. 54.0%, p < 0.001). The incidence of postoperative complications was lower in the arterial group than in the vein group (18.8% < 47.8%, p < 0.05). Diabetes, fibrin degradation products (FDPs) and D-Dimer independently predict patency loss. This study revealed for the first time that FDP levels have a U-shaped relationship with AVF patency (p = 0.009). Diabetes was a stronger predictor in the arterial group, whereas FDP and D-Dimer were more important in the vein group (p < 0.05). CONCLUSION: Compared with venous access, arterial access PTA offered superior primary patency and lower restenosis for juxta-anastomotic AVF lesions. Diabetes, elevated FDP, and D-Dimer predicted patency loss, with the prognostic impact varying according to the vascular access route.