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.

• Klíčová slova
• Cardiovascular Disease, Dialysis, End stage renal failure, Vascular medicine, Vascular surgery,
• MeSH
• arteriovenózní zkrat * škodlivé účinky   MeSH
• cévní přístupy * škodlivé účinky   MeSH
• dialýza ledvin * škodlivé účinky   MeSH
• lidé MeSH
• stenóza klasifikace   etiologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• scoping review MeSH

A prerequisite for the long-term patency of vascular access is early detection of a failing shunt, i.e., at the stage of stenosis. Fistulography performed to locate the lesion is followed by percutaneous transluminal angioplasty using a balloon catheter. The procedure takes 30-60 minutes to complete; the clinical success rate varies between 85% and 98%. A more serious condition of failled vascular access is its occlusion secondary to thrombosis. The high costs of hospitalisation and treatment of thrombosed shunts require effective yet less invasive outpatient procedures. Recent years have seen an explosion in the development of mechanical devices on the principle of mechanical dissolution, fragmentation, and aspiration of the clot. Post-procedural dialysis can be performed immediately thus reducing the need for a central venous catheter. The procedure, particularly in the treatment of native fistula occlusion, is more complicated and about twice as time consuming as treatment of stenosis. The clinical success rate is usually between 71% and 100%. The incidence of serious complications of percutaneous treatment is low.

• MeSH
• arteriovenózní zkrat škodlivé účinky   MeSH
• balónková angioplastika * metody   MeSH
• dialýza ledvin * MeSH
• katetrizace centrálních vén * MeSH
• lidé MeSH
• okluze cévního štěpu terapie   MeSH
• průchodnost cév MeSH
• stenóza MeSH
• trombóza terapie   MeSH
• zaváděcí katétry MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

More than 50% of all end-stage renal disease (ESRD) patients die from cardiovascular complications. Among them, heart failure and pulmonary hypertension play a major role, and published studies document significantly higher mortality rates in patients with these two states. Arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) are the preferred types of vascular access (VA). However, both AVF and AVG increase cardiac output and in turn could contribute to (the decompensation of) heart failure or pulmonary hypertension. No really safe access flow volume exists, and the ESRD patients' reactions to it vary considerably. We review the mechanisms involved in the cardiovascular consequences of increased cardiac output and available literary data. The link between access flow volume and increased mortality due to pulmonary hypertension or heart failure probably exists, but still has not been directly evidenced. Regular echocardiography is advisable especially in patients with symptoms or with high VA flow (>1,500 ml/min).

• MeSH
• arteriovenózní zkrat škodlivé účinky   MeSH
• bezpečnost pacientů * MeSH
• cévní přístupy škodlivé účinky   MeSH
• chronické selhání ledvin terapie   MeSH
• dialýza ledvin škodlivé účinky   MeSH
• echokardiografie MeSH
• hemodynamika fyziologie   MeSH
• lidé MeSH
• minutový srdeční výdej fyziologie   MeSH
• plicní hypertenze etiologie   patofyziologie   prevence a kontrola   MeSH
• srdeční selhání etiologie   patofyziologie   prevence a kontrola   MeSH
• údržba MeSH
• výkony cévní chirurgie škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Access dysfunction presents a risk for haemodialysis patients and is costly for health care providers. Regular vascular access quality (VAQ) monitoring enables the detection of adverse access conditions early allowing timely interventions, which will presumably be less invasive, more successful and cheaper. This paper reviews all currently used assessment parameters: dynamic and static pressures, recirculation and blood flow through the access--and analyses pros and cons of each of them. Based on this overview it is concluded that access flow monitoring should be the method of choice, possibly combined with monitoring of another parameter to further enlarge diagnostic possibilities of the monitoring. The VAQ monitoring system developed and used currently in the author's dialysis centre is briefly described as an example. The issue of access flow related to haemodynamics is briefly mentioned. With the introduction of any VAQ monitoring system, one has to acknowledge a change in structure of interventions and that the demand for surgical procedures decreases with a concurrent increase in percutaneous interventions.

• MeSH
• arteriovenózní zkrat škodlivé účinky   normy   MeSH
• dialýza ledvin přístrojové vybavení   normy   MeSH
• hodnocení rizik metody   MeSH
• krevní tlak MeSH
• laser doppler flowmetrie MeSH
• lidé MeSH
• monitorování fyziologických funkcí metody   normy   MeSH
• okluze cévního štěpu MeSH
• rizikové faktory MeSH
• rychlost toku krve MeSH
• selhání zařízení MeSH
• ukazatele kvality zdravotní péče MeSH
• zajištění kvality zdravotní péče metody   normy   MeSH
• zaváděcí katétry škodlivé účinky   normy   MeSH
• zdravotnické služby - potřeby a požadavky MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

• MeSH
• cévní přístupy škodlivé účinky   MeSH
• dialýza ledvin škodlivé účinky   přístrojové vybavení   metody   MeSH
• kongresy jako téma MeSH
• lidé MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH

Chronic kidney disease is associated with increased cardiovascular morbidity and mortality. A well-functioning vascular access is associated with improved survival and among the available types of vascular access the arterio-venous (AV) fistula is the one associated with the best outcomes. However, AV access may affect heart function and, in some patients, could worsen the clinical status. This review article focuses on the specific cardiovascular hemodynamics of dialysis patients and how it is affected by the AV access; the effects of an excessive increase in AV access flow, leading to high-output heart failure; congestive heart failure in CKD patients and the contraindications to AV access; pulmonary hypertension. In severe heart failure, peritoneal dialysis (PD) might be the better choice for cardiac health, but if contraindicated suggestions for vascular access selection are provided based on the individual clinical presentation. Management of the AV access after kidney transplantation is also addressed, considering the cardiovascular benefit of AV access ligation compared to the advantage of having a functioning AVF as backup in case of allograft failure. In PD patients, who need to switch to hemodialysis, vascular access should be created timely. The influence of AV access in patients undergoing cardiac surgery for valvular or ischemic heart disease is also addressed. Cardiovascular implantable electronic devices are increasingly implanted in dialysis patients, but when doing so, the type and location of vascular access should be considered.

• Klíčová slova
• Chronic kidney disease, arteriovenous fistula, heart failure, hemodialysis, peritoneal dialysis, pulmonary hypertension,
• MeSH
• arteriovenózní píštěl * MeSH
• arteriovenózní zkrat * škodlivé účinky   MeSH
• chronická renální insuficience * diagnóza   terapie   MeSH
• chronické selhání ledvin * MeSH
• dialýza ledvin MeSH
• lidé MeSH
• ligace MeSH
• transplantace ledvin * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

AIMS: The PRACTICE survey aimed to characterize vascular access device (VAD) practices for systemic anti-cancer therapy (SACT) across Europe, addressing gaps in clinician decision-making, training, and complication management. METHODS: Conducted as a cross-sectional survey from May to October 2024, the study engaged healthcare professionals (HCPs) from 18 European countries, with 403 completing demographic questions and 166 responding to procedural and training-related queries. RESULTS: Results revealed significant variability in VAD selection, influenced by institutional protocols, geographic location, and the presence of vascular access teams (VATs). Oncologists were identified as primary decision-makers (36 %), though nursing staff played a pivotal role in daily management. Peripheral intravenous catheters (PIVCs) dominated in Ireland and Finland (43-49 %), while tunnelled implantable devices (TIVADs) were preferred in Belgium (65 %). Barriers to optimal VAD selection included insufficient training (80 % sought further education) and inconsistent guideline adoption (51 % reported institutional protocols). CONCLUSION: The study underscores the need for standardised practices, interdisciplinary collaboration, and enhanced training. Findings highlight opportunities for integrating VAD selection into cancer care certification metrics and fostering partnerships between oncology and vascular access societies.

• Klíčová slova
• Antineoplastic Agents, Professional Practice, Vascular Access Devices,
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Vascular access complications represent leading morbidity of hemodialyzed patients. Duplex Doppler ultrasonography is used rarely in the diagnosis of vascular access complications, despite its simplicity and widespread availability. Our first experience with this method is described, namely the most frequent indications, findings and the access blood flow correlation. METHODS AND RESULTS: 356 examinations of both natural and polytetrafluoroethylene (PTFE) accesses at 193 patients were performed. The 7.5 MHz linear array ultrasound transducer of Hewlett-Packard SONOS 2000 device was used. Both arterial and venous parts of fistulas were examined in all cases. Screening examinations represented the most frequent indication, the hemodynamically significant stenosis the most frequent finding. Only 12.5% of PTFE-shunts and 25.8% of natural fistulas were described as normal. Mean blood flow through antebrachial and brachial accesses was 575 and 1070 ml/min, respectively. CONCLUSIONS: Prevalence of vascular access complications (especially that of stenoses) is high. Wider use of this method could bring significantly improved care for the dialysed patients.

• MeSH
• arteriovenózní zkrat škodlivé účinky   MeSH
• cévy - implantace protéz * škodlivé účinky   MeSH
• dialýza ledvin * MeSH
• lidé MeSH
• okluze cévního štěpu diagnostické zobrazování   MeSH
• paže krevní zásobení   MeSH
• regionální krevní průtok MeSH
• ultrasonografie dopplerovská * MeSH
• zaváděcí katétry škodlivé účinky   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Home parenteral nutrition is the only option to provide nutrition in a number of patients. Care of venous entry, its management and treatment of complications resulting from its use importantly affect patient survival. Appropriate care of the catheter and the use of current knowledge may prolong the lifespan of the catheter, reduce patient morbidity and mortality and thus increase quality of life of patients who are dependent on home parenteral nutrition. The present paper summarizes recommendations for the care of long-term venous catheters.

• MeSH
• cévní přístupy * MeSH
• katetrizace metody   MeSH
• lidé MeSH
• parenterální výživa doma * MeSH
• zaváděcí katétry * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: Long peripheral catheter is 6-15 cm long vascular device. The aim of the study was to compare the frequency of complications of two types of long peripheral catheters with different length inserted in DIVA patients. METHODS: Under ultrasound navigation 2.7F 6.4 cm or 4Fr 12 cm long peripheral catheter was inserted. Complications of both long peripheral catheters were prospectively observed and their relationship to the patient's age, gender, selected vein, number of punctures and Barthel score system was evaluated. RESULTS: Ninety-three 12 cm and fifty-five 6.4 cm long peripheral catheters were inserted. Median of dwelling time was 8 days for 6.4 cm and 9 days for 12 cm long peripheral catheter. There were 17 (26%) complications in 6.4 cm (38/1000 catheter days) and 15 (16%) in 12 cm catheter (17/1000 catheter days), p = 0.04. The complications of both peripheral catheters were not associated with the age of patients, gender, number of punctures and selected vein for insertion. Unlike 12 cm catheter, the complications of 6.4 cm long peripheral catheter were significantly associated with the result of Barthel scoring system (p = 0.003). CONCLUSION: The frequency of complications was more common with 6,4 cm than with 12 cm catheter.

• Klíčová slova
• Barthel scoring system, Long peripheral catheter, complication, vascular access,
• MeSH
• intravenózní podání MeSH
• katétry MeSH
• lidé MeSH
• periferní katetrizace * škodlivé účinky   MeSH
• punkce MeSH
• ultrasonografie MeSH
• zaváděcí katétry MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH