ArticleFrontiers in cardiovascular medicine2026
Anatomical lesion extent and recurrent failure after balloon angioplasty in arteriovenous fistulas: a competing-risk analysis.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Background: Risk stratification for arteriovenous fistula (AVF) re-failure after percutaneous transluminal angioplasty (PTA) relies on systemic comorbidity markers. These markers are costly and inconsistently predictive in resource-limited settings. We hypothesized that intraoperative digital subtraction angiography (DSA) variables, lesion length and lesion morphology, could stratify the risk of re-failure without additional testing. Methods: This single-center retrospective derivation study included 243 patients with successful PTA using uniform Mustang™ balloons. We used Fine-Gray subdistribution hazard models with death and kidney transplantation as competing events. Missing data were handled by multiple imputation. Model discrimination and calibration were assessed by optimism-corrected C-index via 500 bootstrap resamples and calibration plots. Lesion length was modelled with a restricted cubic spline (3 knots); lesion location was analysed as four mutually exclusive categories with anastomotic/peri-anastomotic stenosis as the reference. Calibration was assessed in quintiles of predicted 1-year cumulative incidence. Results: During follow-up, 103 patients (42.4%) experienced re-failure and 24 (9.9%) had competing events. Lesion length showed a strong non-linear association with re-failure (test for non-linearity, Conclusion: Intraoperative DSA-derived lesion length showed a strong, markedly non-linear association with AVF re-failure after PTA and carried nearly all of the discriminative ability of the model; the apparent effect of composite morphology was substantially attenuated once length was modelled appropriately, indicating that morphology acts in part as a surrogate for lesion extent. Because vessel diameter, stenosis severity, local calcification and procedural parameters were not available, these findings are hypothesis-generating and require prospective external validation with comprehensive lesion characterisation before any clinical implementation.
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