{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T09:38:14Z","timestamp":1786527494630,"version":"build-2736575974"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center retrospective derivation study included 243 patients with successful PTA using uniform Mustang\u2122 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). Relative to the median length of 1.75\u2005cm, the subdistribution hazard ratio (SHR) was 0.25 (95% CI, 0.20\u20130.32) at 1\u2005cm, 1.46 (95% CI, 1.37\u20131.56) at 2\u2005cm and 4.31 (95% CI, 3.37\u20135.51) at 3\u2005cm. Once lesion length was modelled as a spline, the effect of composite morphology was attenuated by 35%, from 2.81 (95% CI, 1.70\u20134.66) under a linear specification to 1.83 (95% CI, 1.13\u20132.97) (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.014). The final model achieved an optimism-corrected C-index of 0.79 at 1 year and 0.80 at 2 years. Age, diabetes and coronary artery calcium score showed no significant association.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1906106","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T09:10:21Z","timestamp":1786525821000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Anatomical lesion extent and recurrent failure after balloon angioplasty in arteriovenous fistulas: a competing-risk analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Kelong","family":"Shi","sequence":"first","affiliation":[{"name":"Bengbu Medical University","place":["Bengbu, Anhui, China"]},{"name":"Tongling People's Hospital, Tongling, 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