Classifications of haemodialysis vascular access-induced limb ischaemia Katerina Lawrie, Stephen O’Neill, Jan Malik, Peter Balaz, Michael Corr, et al. Journal of Vascular Access, 2026 Vascular access-induced limb ischaemia is a potentially severe complication. A classification system for clinical assessment and treatment would be a useful clinical tool for standardising management. There are several classifications described in the current literature using inconsistent terminology. The aim of this review is to identify all the reported classification systems of vascular access-induced limb ischaemia and to present a comprehensive summary. PubMed, Scopus, Web of Science, Google Scholar and the ClinicalTrials.gov registry were searched from inception to the 17th of October 2024. All articles containing newly proposed classifications regarding haemodialysis vascular access were eligible. There were no restrictions to the full text’s language or the type of study. The classifications were evaluated using a modified Buchbinder’s classification critical appraisal tool. From 4694 screened papers, 59 full-text papers were retrieved, and eight articles contained classifications based only on the severity of vascular access-induced limb ischaemia. According to the modified Buchbinder critical appraisal, the classifications identified were overall good quality. The systems are all based on clinical symptoms but use inconsistent terminology and do not consider various aetiologies. We present a summary and propose a unified classification based on the anatomical location of the pathology, which leads to high- or low-flow ischaemia, along with a suitable therapeutic approach for each type.
Improvement of the left atrial systolic function after a surgical reduction of the high flow arteriovenous fistula Vaclav Lejsek, Anna Valerianova, Kristyna Michalickova, Kristina Buryskova Salajova, Marcela Slavikova, et al. Frontiers in Medicine, 2026 Background High-output heart failure (HOHF) is a distinct cardiac complication in end-stage kidney disease (ESKD) patients with high-flow arteriovenous fistulae (AVFs). While AVF flow reduction improves hemodynamics and left atrial (LA) volume, its effect on LA systolic function remains unclear. Objective To evaluate changes in left atrial systolic function and left ventricular (LV) filling pressures following surgical AVF flow reduction in haemodialysis patients with high-flow fistulae. Methods In this prospective, single-centre interventional study, 28 ESKD patients (mean age 63 ± 15 years) with high-flow AVFs (>1,500 mL/min) and clinical heart failure (NYHA ≥ II) underwent surgical AVF flow reduction. Echocardiographic assessments were performed before and 6 weeks after intervention. LA ejection fraction (LAEF) and LV filling pressures (E/e′ ratio) were determined from digitally stored imaging data. Results Surgical intervention reduced AVF flow by approximately 50% [2,525 [1,388] to 1,250 [700] mL/min, p = 0.00006]. LA volume index decreased significantly (44.7 ± 17.3 to 38.5 ± 15.4 mL/m 2 , p = 0.01), accompanied by an improvement in LAEF (49.6 ± 14.9% to 53.2 ± 13.5%, p = 0.046). Dyspnoea improved or resolved in all patients. Baseline LAEF correlated negatively with age, LA volume index, and NYHA class, but no independent predictors of post-operative LAEF improvement were identified. Conclusions In patients with high-flow AVF–associated HOHF, surgical AVF flow reduction leads to a significant improvement in LA systolic function alongside decreased LA volume. These findings suggest partial reversibility of atrial remodeling induced by chronic hyperkinetic circulation and highlight the potential cardiovascular benefits of AVF flow optimization in selected dialysis patients.
Using ultrasound in preoperative mapping and surveillance of arteriovenous grafts for haemodialysis improves patency rates: Single-centre experience Julia Jarosciakova, Petr Utikal, Jan Malik, Jana Janeckova Journal of Vascular Access, 2025 Background: This study aimed to evaluate patency outcomes of arteriovenous grafts (AVGs) before and after using Duplex doppler ultrasonography (DUS) in preoperative mapping and surveillance of AVG. Methods: In this single-centre, retrospective cohort study 212 patients receiving AVGs from January 2009 to December 2022 were included. In group 1, the creation of AVG as well as screening was based on physical examination alone. In contrast, DUS was used in the preoperative mapping and surveillance of AVG in group 2. The patients also received sulodexide as supplemental medication. Outcomes included primary and secondary patency. The Mann-Whitney U-test was used to compare the differences between groups in number of thrombectomies and preemptive percutaneous transluminal angioplasties (PTAs). Results: Group 1 included 90 AVGs. The mean follow-up time was 333 days (range: 1–1230 days, standard deviation: 318 days). The primary and secondary graft patency rates were 13.3%, 62.2% at 6 months; 2.2%, 52.1% at 12 months; 0%, 44.3% at 24 months and 0%, 44.3% at 36 months respectively. During the 7-year surveillance of AVG, significantly more thrombectomies were performed than preemptive PTA ( p < 0.0001). Group 2 included 122 AVGs. The mean follow-up time was 584 days (range: 1–2040 days, standard deviation: 463 days). The primary and secondary graft patency rates were 54.9%, 95.9% at 6 months; 29.5%, 77.8% at 12 months; and 9.8%, 56.5% at 24 months; 2.5%, 47.1% at 36 months respectively. The primary and secondary graft patency was significantly longer ( p < 0.0001, p = 0.002). During the 7-year surveillance of AVG there were significantly more preemptive PTAs performed ( p = 0.0004). Conclusions: The primary and secondary patency of AVG were significantly improved after using DUS in preoperative mapping and surveillance. DUS surveillance led to a decrease in AVG occlusion. A potential positive effect of sulodexide on patency rate of AVG needs more research.