Early Recurrent Arteriovenous Fistula Stenosis: Identifying Patients Most Likely to Benefit From Drug-Coated Balloon Therapy

Objective To evaluate the outcomes of drug-coated balloon (DCB) vs high-pressure balloon (HPB) angioplasty for the treatment of early recurrent arteriovenous fistula (AVF) stenosis. Methods This retrospective study analyzed 164 maintenance hemodialysis patients treated for early recurrent AVF stenosis (recurrence within 6 months) between 2019 and 2024. Patients were stratified into DCB and HPB groups. Propensity score matching (PSM) was utilized to balance baseline characteristics, resulting in 60 pairs for final analysis. The primary endpoint was target lesion primary patency (TLPP) at 180 days. Results In the matched cohort, the DCB group demonstrated significantly lower restenosis rates compared to the HPB group, at 15.00% vs 38.33% at 180 days and 33.33% vs 58.33% at 1 year (Log-rank P < 0.05). While vessel diameters remained comparable, access blood flow volume at 1 year was higher in the DCB group ( P < 0.05). Multivariate Cox regression indicated that DCB treatment was associated with a lower risk of patency loss (HR: 0.16; 95% CI: 0.07-0.37). Restricted mean survival time analysis suggested an average gain of 20.2 patency days over 180 days in the DCB group. Conclusion For early recurrent AVF stenosis—a clinical subgroup likely driven by biologically aggressive neointimal hyperplasia rather than simple mechanical recoil—DCB angioplasty provides better mid-term patency retention and hemodynamic preservation than HPB, supporting the clinical justification of targeted antiproliferative therapy in this specific cohort.