Larger balloon diameter improves vascular resistance in arteriovenous access: A retrospective analysis

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BACKGROUND: Percutaneous transluminal angioplasty (PTA) effectively treats hemodialysis access stenosis; however, restenosis remains common, partly due to variability in balloon diameter selection. To address this issue, we evaluated the utility of a simple +1-mm upsizing strategy using the same balloon type. METHODS: This retrospective cohort study was conducted at Tokai Central Hospital between September 2021 and August 2025. We analyzed 17 PTA procedures in 15 maintenance hemodialysis patients who underwent regularly scheduled PTA for recurrent stenosis. To minimize device-related variability, only sessions in which the same balloon type was used and upsized by +1 mm were included. Vascular resistance, blood flow, and vessel diameter were assessed by duplex ultrasonography following a standardized protocol. RESULTS: No adverse events occurred. Balloon upsizing significantly improved vascular resistance and vessel diameter, demonstrated a trend toward increased blood flow, and showed a tendency to prolong the interval between PTA sessions. CONCLUSIONS: A +1-mm balloon upsizing strategy improves hemodynamics without increasing complications and may represent a safe, practical enhancement to PTA management of hemodialysis access.

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