Abstract: Objective  This study aimed to explore the risk factors for restenosis of the juxta-anastomotic stenosis in radial-cephalic arteriovenous fistula (RC-AVF) after primary percutaneous transluminal angioplasty (PTA).  Methods  A single-center prospective study was conducted, to analyze the patients with arteriovenous fistula (AVF) undergoing PTA treatment between January, 2021 and June 2022. Their demographics, lesional characteristics, technical factors, and auxiliary examination results were collected. Risk factors for restenosis after PTA were evaluated using univariate and multivariable analyses.  Results  A total of 114 patients with RC-AVF successfully completed the first PTA treatment with a technical success rate of 95.0% (114/120), and 112 patients finished follow-up the primary assistant patency time was 512.15±226.32 days, and the secondary patency time was 554.88±205.67 days. After PTA for 90, 180, 360, and 540 days, the primary patency rates were 94.6%, 81.3%, 56.1%, and 33.3%, respectively; the primary assistant patency rates were 97.3%, 95.5%, 85.1%, and 70.1%, respectively; the secondary patency rates were 100%, 100%, 95.7%, and 85.7%, respectively. Cox regression analysis showed that balloon diameter (HR=0.62，95% CI: 0.43～0.89, P=0.009) was the independent predicting factor for primary patency loss after PTA. ROC curve analysis showed an AUC area of 0.614 (95% CI: 0.510～0.718, P=0.037) and a critical value of 6.0 mm. Stenosis length (HR=1.04, 95% CI: 1.02～1.07, P<0.001) and stenosis number (HR=3.73, 95% CI: 1.32～10.54, P=0.013) were the independent predicting factors for primary assistant patency loss after PTA, with AUC areas of 0.686 (95% CI: 0.543～0.838, P=0.009) and 0.685 (95% CI: 0.559～0.810, P=0.010), critical values of 17.5 mm and 2.   Conclusions Restenosis of the juxta-anastomotic venous stenosis in RC-AVF after primary PTA remains high. Balloon diameter is closely related to the restenosis after PTA. The use of a balloon with a maximum diameter <6 mm is an independent predictor for primary patency loss after PTA. Longer stenosis (≥17.5 mm) and stenosis number ≥2 are the independent predictors for primary assistant patency loss after PTA. 

Key words: Autogenous arteriovenous fistula, Juxta-anastomotic stenosis; , Percutaneous transluminal angioplasty, Risk Factor