OBJECTIVES: Vascular access (VA) stenoses play a significant role in the morbidity of the haemodialysed population. Classifications for diagnosis, assessment and proposal of treatment strategies can be useful clinical and methodological tools. This review aims to present a comprehensive summary and propose further methodological approaches. DESIGN: A systematic review of the literature, evaluating classifications for dialysis-related VA stenosis. DATA SOURCES: Web of Science, Scopus, PubMed, Google Scholar and the ClinicalTrials.gov registry were searched from inception to 7 December 2024. ELIGIBILITY CRITERIA: All articles containing classifications regarding dialysis VA were eligible, with no restrictions on the study type or language of the full text. DATA EXTRACTION AND SYNTHESIS: Two independent researchers performed the search and initial screening. Four vascular surgeons assessed the included classifications using a modified Buchbinder's critical appraisal tool to evaluate quality. RESULTS: From 4771 screened papers, 59 full-text papers were retrieved and 24 articles contained classifications. Three classifications were dedicated to VA stenosis, all based on the anatomical location of lesions. According to the modified Buchbinder's appraisal, the classifications were assessed as moderate-to-good quality. The literature disposes of immense inconsistency in terms of the definition of significant stenosis indicated for treatment. CONCLUSIONS: VA significant stenosis and its classification is a non-uniformly understood issue with many different criteria and categorisations. This basic methodological problem leads to inconsistent results. We recommend the unification of the criteria and their validation in prospective studies.

• Keywords
• Cardiovascular Disease, Dialysis, End stage renal failure, Vascular medicine, Vascular surgery,
• MeSH
• Arteriovenous Shunt, Surgical * adverse effects   MeSH
• Vascular Access Devices * adverse effects   MeSH
• Renal Dialysis * adverse effects   MeSH
• Humans MeSH
• Constriction, Pathologic classification   etiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Scoping Review MeSH

Dialysis access-related distal ischaemia is a rare yet potentially rather risky complication of haemodialysis angioaccess. Timely diagnosis is crucial to target both the goals of the access team: first of all to preserve the function of the hand ideally along with angioaccess patency. Unfortunately for some patients, urgent access ligation and central vein catheter insertion would be needed to save the hand. After a first clinical examination to determine the diagnostic suspicion, the ultrasound evaluation would provide nearly all the needed information to confirm the diagnosis and to determine the most appropriate procedure to rescue the patient from distal ischaemia. In some cases, photoplethysmography would help in the differential diagnosis of other non-ischaemic causes of similar signs and symptoms. Angiography would complete the preoperative evaluation for some.Dialysis access-related distal ischaemia would be briefly reviewed, and a deep description of the ultrasound examination tools and findings would be provided for a tailored therapeutic approach.

• Keywords
• AV fistula, dialysis, dialysis access-related distal ischaemia, techniques and procedures, ultrasonography–Doppler evaluation,
• MeSH
• Arteriovenous Shunt, Surgical * adverse effects   MeSH
• Renal Dialysis MeSH
• Ischemia diagnostic imaging   etiology   therapy   MeSH
• Humans MeSH
• Ligation MeSH
• Vascular Patency MeSH
• Hand MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH

Chronic hemodialysis therapy required regular entry into the patient's blood stream with adequate flow. The use of arteriovenous fistulas and grafts is linked with lower morbidity and mortality than the use of catheters. However, these types of accesses are frequently affected by stenoses, which decrease the flow and lead to both inadequate dialysis and access thrombosis. The idea of duplex Doppler ultrasound surveillance is based on the presumption that in-time diagnosis of an asymptomatic significant stenosis and its treatment prolongs access patency. Details of performed trials are conflicting, and current guidelines do not support ultrasound surveillance. This review article summarizes the trials performed and focuses on the reasons of conflicting results. We stress the need of precise standardized criteria of significant access stenosis and the weakness of the metaanalyses performed.

• Keywords
• Hemodialysis, arteriovenous fistula, arteriovenous graft, hemodialysis vascular access, ultrasonography,
• MeSH
• Arteriovenous Shunt, Surgical * adverse effects   MeSH
• Renal Dialysis MeSH
• Ultrasonography, Doppler, Duplex MeSH
• Humans MeSH
• Graft Occlusion, Vascular diagnostic imaging   etiology   therapy   MeSH
• Vascular Patency MeSH
• Ultrasonography MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH