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Abstract Arteriovenous fistula (AVF) is a frequently performed surgical procedure in end-stage renal disease patients for hemodialysis access. However, AVFs may encounter occasional failure, requiring further interventions to restore or maintain dialysis access. This study aims to compare the effectiveness of percutaneous transluminal angioplasty (PTA) and open surgery as treatment options for failing AVFs. By assessing outcomes, complications, and success rates of both interventions, the research aims to provide insights into the optimal management strategy for patients with failed AVFs. A total of 45 patients with failed AVFs were included, divided into PTA (13 patients) and open surgery (34 patients) groups. Patient demographics, including age, gender, and comorbidities, were recorded. The retrospective study utilized patient data from medical records and imaging studies, analyzing clinical characteristics, procedure details, and postoperative outcomes. Results showed technical success rates of 84.6% for PTA and 94.1% for open surgery. While complications were similar, minor complications were more common in the PTA group. The study suggests that both PTA and open surgery are viable options for managing failing AVFs, emphasizing the importance of individualized treatment selection based on patient factors. Despite PTA being less invasive, it is associated with a higher likelihood of subsequent interventions. The decision between modalities should consider anatomical characteristics, comorbidities, and surgeon expertise. |