Meta-analysis identifies risk factors for patency loss after PTA in hemodialysis patients

This systematic review and meta-analysis identified factors influencing patency after percutaneous transluminal angioplasty (PTA) for autogenous arteriovenous fistulae (AVF) in hemodialysis patients. Literature through July 2025 was searched for observational and randomized trials. Two reviewers independently performed study selection, quality assessment (Newcastle-Ottawa Scale/Cochrane tool), and data extraction. Meta-analyses used fixed-/random-effects models in R (per I statistic), with sensitivity and publication bias analyses. Fifty-two studies ( = 6,407) were included, 45 of high quality. For primary patency, independent risk factors were diabetes (OR = 1.02, 95% CI 1.01-1.02), lesion length >2 cm (OR = 2.87, 1.38-5.96), previous intervention (OR = 3.13, 1.69-5.79), failed AVF history (OR = 1.69, 1.22-2.35), brachiocephalic configuration (vs. radiocephalic, OR = 1.73, 1.33-2.26), vascular calcification, and multiple comorbidities. High post-PTA flow was protective, and drug-coated balloons outperformed conventional angioplasty. Secondary patency was compromised by diabetes (OR = 1.05, 95% CI 1.02-1.08), longer lesions (OR = 1.01, 95% CI 1.01-1.02), and residual stenosis (OR = 1.02, 95% CI 1.01-1.04), with procedural success protective. Intimal hyperplasia strongly predicted failure. Restenosis risk was elevated by diabetes (OR = 1.72, 95% CI 1.28-2.31) and hypertension (OR = 1.59, 95% CI 1.04-2.44), while medical therapy with nitrates (OR = 0.20, 95% CI 0.05-0.79) and higher albumin were protective. Conventional biomarkers had limited value. Long-term AVF patency after PTA depends on anatomical, historical, and pathological factors, emphasizing the need to target modifiable procedural and hemodynamic variables in clinical practice.