{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:28:22Z","timestamp":1793125702239,"version":"4.5.0"},"reference-count":24,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Seminars in Dialysis"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The transradial approach (TRA) is a critical access method for percutaneous transluminal angioplasty (PTA) in hemodialysis (HD) patients with arteriovenous fistula (AVF) dysfunction, yet its technical challenges remain unaddressed. Currently, no predictive tools exist to assess TRA feasibility. This study aimed to identify risk factors for difficult TRA and develop a predictive nomogram.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed 160 HD patients undergoing ultrasound\u2010guided TRA\u2010PTA across three Chinese hospitals (May 2022\u2013May 2024). A training cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009110) and validation cohort (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200950) were established. Independent risk factors were identified via univariate and multivariate logistic regression. A nomogram was constructed and validated using ROC curves, calibration plots, and decision curve analysis (DCA).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort had a mean age of 59.7\u2009\u00b1\u200912.9\u2009years, with 36.9% (59\/160) experiencing difficult TRA. Radial artery diameter (OR\u2009=\u20092.1,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003), calcification (OR\u2009=\u20093.4,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and tortuosity (OR\u2009=\u20092.8,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002) were independent predictors. The nomogram demonstrated strong discrimination (AUC: 0.902), with sensitivity\u2009=\u20090.907 and specificity\u2009=\u20090.806 at a cutoff of 0.416. Calibration showed excellent agreement (mean absolute error\u2009=\u20090.022), and DCA confirmed clinical utility across threshold probabilities of 0.2\u20130.8.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This nomogram demonstrates that for optimal puncture feasibility, the radial artery diameter should be \u2265\u20093\u2009mm when both calcification and tortuosity are present, &gt;\u20092.2\u2009mm if either condition is present, and &gt;\u20091.5\u2009mm if neither is present. The nomogram effectively predicts difficult TRA during AVF\u2010PTA in HD patients, offering clinicians a practical tool to preoperatively assess procedural feasibility and optimize vascular access planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/sdi.70027","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:05:32Z","timestamp":1777507532000},"page":"88-96","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Development and Validation of a Nomogram to Predict the Difficult Transradial Approach for Percutaneous Transluminal Angioplasty in Radiocephalic Arteriovenous Fistulas"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5937-5112","authenticated-orcid":false,"given":"Jiali","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Nephrology Affiliated Hospital of North Sichuan Medical College  Nanchong Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Tongji Hospital, School of Medicine Tongji University  Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiqiang","family":"Duan","sequence":"additional","affiliation":[{"name":"Department of Nephrology Western Theater Air Force Hospital  Chengdu Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Yin","sequence":"additional","affiliation":[{"name":"Anqing Shengtong Nephropathy Hospital  Anqing Anhui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-7027-2797","authenticated-orcid":false,"given":"Heping","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Nephrology Affiliated Hospital of North Sichuan Medical College  Nanchong Sichuan China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2019.12.001"},{"issue":"3","key":"e_1_2_9_3_1","first-page":"658","article-title":"Clinical Efficacy of the Transradial Approach in Percutaneous Intervention for a Malfunctioning Arteriovenous Fistula","volume":"83","author":"Choi H. 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