ObjectiveTo evaluate the long-term patency outcomes of radiocephalic arteriovenous fistulas treated with percutaneous transluminal angioplasty for radial artery stenosis, with a particular focus on the clinical impact of percutaneous transluminal angioplasty-induced radial artery rupture and its endovascular management.MethodsThis single-center retrospective analysis involved all patients diagnosed with arteriovenous fistula dysfunction and radial artery stenosis who were treated with arterial percutaneous transluminal angioplasty at our department from January 2021 to September 2024. In total, 56 patients were ultimately included in the study.ResultsTechnical success was achieved in all patients. Radial artery rupture occurred in 10 of the 56 patients (17.86%) during percutaneous transluminal angioplasty and was successfully managed using prolonged low-pressure balloon inflation combined with localized external compression, without the need for covered stent implantation or surgical repair. At 1 year, primary patency rates were 40.0% in the rupture group and 39.1% in the normal group ( p  = 0.53), whereas the corresponding secondary patency rates were 90.0% and 87.0%, respectively ( p  = 0.35).ConclusionPercutaneous transluminal angioplasty is an effective treatment for radiocephalic arteriovenous fistula dysfunction caused by radial artery stenosis. Although dilation-induced radial artery rupture was relatively common in our cohort, it may be safely managed with prolonged low-pressure balloon inflation and localized compression without routine stent implantation or surgical intervention. Importantly, radial artery rupture did not appear to compromise long-term access-circuit patency. These findings apply to overall access-circuit outcomes rather than lesion-level durability. Controlled arterial rupture during percutaneous transluminal angioplasty appears to be a manageable procedural event that was not associated with worse overall access-circuit outcomes in this cohort.