Ultrasound-guided sharp recanalization for valve-related stenosis in the arteriovenous fistula: a single-center retrospective cohort study

To compare the efficacy and safety of ultrasound-guided sharp recanalization (USR) with those of conventional percutaneous transluminal angioplasty (PTA) in the treatment of venous valve-related stenosis (VVRS) in arteriovenous fistulas (AVFs). This single-center retrospective cohort study included patients treated between January 2023 and June 2024. Seventy-eight patients met the inclusion criteria; after excluding 13 patients lost to follow-up, 65 were analyzed (USR n = 33; PTA n = 32). One-to-one propensity score matching generated 32 matched pairs (USR n = 32; PTA n = 32). The primary outcome was 12-month primary patency; secondary outcomes included technical success, time to restenosis, and complications.After propensity score matching, 32 matched pairs were analyzed. In the matched cohort, 12-month primary patency was higher with USR than with PTA (62.5% vs. 25.0%; HR = 0.36, 95% CI 0.18–0.70; P = 0.002). Mean time to restenosis was longer in the USR group (8.25 ± 3.42 vs. 4.48 ± 2.87 months; P = 0.021). Complications were not significantly different between groups (USR 11/32 vs. PTA 5/32), and none required open surgical intervention. USR may improve 12-month primary patency in VVRS compared with PTA without an observed increase in complications. Larger multicenter prospective studies are needed to confirm these findings.