Objective To explore the effect of the maximum dilatation pressure of percutaneous transluminal angioplasty(PTA) balloon on the patency rate of arteriovenous fistula stenosis within 12 months after PTA, and screen out the independent risk factors that affect restenosis after PTA. Methods A hundred patients, admitted and successfully undergone PTA in the Department of Nephrology, the Third Hospital of Hebei Medical University during January to December 2019, were recruited as the subjects, and of them the basic information, primary medical history, comorbidities, related serological indicators and types of fistula stenosis were collected. The internal fistula patency of patients for 12 months after PTA surgery was traced and collected through outpatient or telephone follow-up. According to the maximum pressure required to expand the stenosis during the operation, the patients were divided into high-pressure group (the maximum balloon pressure required to expand the stenosis ≥20 atm) and low-pressure group (the maximum balloon pressure required to expand the stenosis <20 atm), The basic information, primary medical history, comorbidities, related serological indicators and postoperative patency rate were compared between the two groups, and the risk factors leading to restenosis of internal fistula after PTA were analyzed by COX survival analysis. The receiver operating characteristic (ROC) curve was employed to evaluate the predictive value of the maximum balloon inflation pressure for restenosis within 12 months after PTA. Results A total of 100 patients were enrolled in present study, including 48 males and 52 females with average age of (53.21±15.75) years, the median dialysis age at PTA of 24.0 (12.0, 49.5) months, and the median duration of fistula of 12.6 (5.1, 37.4) months. All patients were completely followed up. The rates of diabetic kidney disease in primary diseases,hypertension and the restenosis rate within 12 months after PTA were higher in high-pressure group than those in low-pressure group with statistically significance (P<0.05). The patency rate within 12 months after PTA was higher in low-pressure group than that in high-pressure group (Log-rank test, χ²=5.399, P=0.020). Cox multivariate survival analysis showed that the maximum expansion pressure required to expand the stenosis and hypomagnesemia were the independent risk factors for restenosis after PTA(P<0.05). ROC curve analysis showed that the area under the curve (AUC) of the maximum balloon inflation pressure during PTA was 0.619 (95%CI 0.496-0.742, P<0.05), which has diagnostic value. The best critical value for the maximum balloon dilatation pressure was 19atm, the sensitivity was 60.5%, and the specificity was 66.1%. Conclusions Patients who require higher expansion pressure during PTA are more likely to have restenosis within 12 months after PTA. The maximum expansion pressure required to expand the stenosis during PTA and hypomagnesemia are the independent risk factors for patency after PTA.