Classifications of haemodialysis vascular access-induced limb ischaemia

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.