Objective To evaluate the efficacy of paclitaxel-coated balloon angioplasty (PCB) in treating recurrent stenosis of vascular access and investigate risk factors affecting target lesion patency time.

Methods A retrospective study included 81 patients with recurrent stenosis of vascular access. The patients were divided into the paclitaxel-coated balloon group (PCB, n = 40) and conventional high-pressure balloon group (HPB, n = 41) based on treatment methods. The study compared surgical techniques, clinical success rates, preoperative/postoperative stenotic diameter, dialysis blood flow, primary stenosis patency rates at 1, 3, 6, 9, and 12 months, postoperative complications within 1 month, and potential risk factors.

Results No statistically significant differences were observed in preoperative stenotic diameter or dialysis blood flow between the two groups (P ＞ 0.05). The PCB group showed significantly better postoperative stenotic diameter and dialysis blood flow compared to the HPB group (P ＜ 0.05). The median postoperative stenosis patency time was 5.55 months in the PCB group versus 4.90 months in the HPB group (Z = 1.27, P ＞ 0.05). No statistically significant differences were found in primary stenosis patency rates at 1, 3, 6, 9, and 12 months (P ＞ 0.05), nor in postoperative complication rates within 1 month (P ＞ 0.05). Cox regression analysis revealed that the number of stenotic lesions at 12 months postoperatively was an independent risk factor for postoperative stenosis patency time (HR = 0.598, 95%CI: 0.370–0.966, P ＜ 0.05).

Conclusion Compared with conventional high-pressure balloon angioplasty, paclitaxel-coated balloon angioplasty demonstrates certain advantages in treating recurrent stenosis of vascular access. It effectively dilates the stenotic area and increases dialysis blood flow, making it a safe and effective option for managing recurrent stenosis. The number of stenotic sites is a risk factor affecting the patency duration of the vascular access postoperatively.