Significance and Method of Balloon Angioplasty for Arteriovenous Fistula in Dialysis Patients with Residual Stenosis ≤ 30% as a Success Indicator

Background Generally, the success indicator for vascular access intervention (VAI) for arteriovenous fistulas (AVF) is a residual stenosis ≤30%. However, there is insufficient comparative data on patency and clinical outcomes between patients who achieve this threshold and those who do not. Furthermore, the optimal approach to achieve this target remains unclear. This study aims to identify effective strategies for achieving a residual stenosis ≤30% following balloon angioplasty, and evaluate associated patency rates. Materials and Methods A total of 198 patients underwent VAI (balloon angioplasty) for focal stenotic lesions of AVF in the forearm or anatomical snuff box. Patients were divided into two groups: (i) with a residual stenosis ≤30% after balloon dilation (expanded group, n = 60) and (ii) with a residual stenosis of ≥30% (non-expanded group, n = 138) and compared. Results The expanded group had a significantly larger balloon size (4.85±0.91 mm vs. 4.45±0.79 mm, p <0.001) and a higher balloon-to-vessel ratio (1.12±0.51 vs. 0.96±0.45, p <0.001). Receiver operating characteristic (ROC) analysis identified 0.96 as the optimal balloon-to-vessel ratio cutoff for achieving ≤30% residual stenosis. Scoring balloons were also used significantly more in the expanded group (36.7% vs. 17.3%, p =0.003). Patients in the expanded group had a significantly higher 1-year primary patency rate (93.3% vs. 82.6%, p =0.04). Conclusion Selecting a balloon with a balloon-to-vessel ratio ≥0.96 and utilizing a scoring balloon are effective strategies for reducing residual stenosis to ≤30%. Achieving this threshold is associated with improved 1-year primary patency rates.