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

Arteriovenous fistula (AVF) is currently the hemodialysis access with the longest life expectations for the patients. However, even the AVF is at risk for many complications, especially the development of stenosis. The latter can not only lead to inadequate hemodialysis but also lead to AVF thrombosis. Duplex Doppler ultrasonography is a very precise method, in the hands of experienced professionals, for the diagnosis of AVF complications. In this review, we summarize the ultrasound diagnostic criteria of significant stenoses and their indication for procedural therapy.

• Keywords
• arteriovenous fistula, arteriovenous graft, hemodialysis, vascular ultrasonography,
• Publication type
• Journal Article MeSH
• Review MeSH

The goal of vascular access creation is to achieve a functioning arteriovenous fistula (AVF) or arteriovenous graft (AVG). An autologous fistula has been shown to be superior to AVG or to central venous catheters (CVCs) with lowest rate of re-intervention, but vessel obstruction or immaturity accounts for 20 % to 54% of cases with primary failure of AVF. This review is focused on the factors influencing maturation; indication and timing of preoperative mapping/creation of vascular access; ultrasound parameters for creation AVF/AVG; early postoperative complications following creation of a vascular access; ultrasound determinants of fistula maturation and endovascular intervention in vascular access with maturation failure. However, vascular accesses that fail to develop, have a high incidence of correctable abnormalities, and these need to be promptly recognized by ultrasonography and managed effectively if a high success rate is to be expected. We review approaches to promoting fistula maturation and duplex ultrasonography (DUS) of evaluating vascular access maturation.

• Keywords
• Hemodialysis, arteriovenous fistula, maturation, ultrasound, vascular access,
• MeSH
• Arteriovenous Shunt, Surgical * adverse effects   MeSH
• Renal Dialysis MeSH
• Ultrasonography, Doppler, Duplex MeSH
• Humans MeSH
• Vascular Patency MeSH
• Retrospective Studies MeSH
• Ultrasonography MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review 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