Objective To investigate the influence of venous diameter on the success of autogenous arteriovenous fistula (AVF) plasty. Methods A retrospective study was conducted on patients hospitalized in Sichuan Provincial People's Hospital from January 2023 to August 2023. All patients underwent their first autogenous arteriovenous fistula plasty, with the AVF located in the forearm involving the cephalic vein and radial artery. End-to-side anastomosis technique was used for all patients. The general data, laboratory data, vascular ultrasound and AVF operation records were collected. Based on the result of autogenous arteriovenous fistula plasty, patients were divided into the surgical success group and the surgical failure group, and their data were compared. Logistic regression analysis was used to identify factors influencing the success of arteriovenous fistula plasty. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive value of each influencing factor for arteriovenous fistula plasty. Results A total of 170 patients were included in the study, with 151 patients in the surgical success group and 19 patients in the surgical failure group. There were no significant differences between the two groups in terms of age, height, weight, BMI, hemoglobin, albumin, urea, creatinine, uric acid, calcium, phosphate, C-reactive protein, brain natriuretic peptide, prothrombin time, AVF anastomosis size, or arterial diameter (P>0.05). However, statistically significant differences were found in terms of platelet count and venous diameter (P<0.05). Multivariable Logistic regression analysis revealed that platelet count (OR=0.993，95％CI 0.987-0.998，P=0.013) and venous diameter (OR=4.719，95％CI 1.742-12.782，P=0.002) were independent influencing factors for surgical success. ROC curve analysis showed that venous diameter (AUC=0.705, 95% CI 0.583-0.827, P=0.004，cut-off value=0.215 cm) was an important indicator for predicting surgical success. Conclusion Venous diameter is an important factor for predicting the success of arteriovenous fistula plasty. Therefore, careful consideration should be given to venous diameter during the preoperative evaluation of arteriovenous fistula plasty