CX to highlight impact of high-flow arteriovenous fistulas in Vascular Access session

vascular access
Nicholas Inston

Nicholas Inston (Queen Elizabeth Hospital Birmingham, Birmingham, UK) speaks to Vascular News ahead of this year’s Charing Cross Symposium (CX), which is being held online 19–22 April. In 2021, the conference will focus on controversies within the vascular and endovascular space.

Could you outline the Vascular Access highlights from the programme you have put together for CX 2021?

The CX 2021 Vascular Access programme as usual covers a lot of ground, but there are some real highlights this year. We are going to start the day by talking about device-created fistulas, and of course we now have the options of surgically-created or device-created fistulas. Where we use these, how we use these, and what are the expected outcomes will be discussed. We are also going to delve into the field of high-flow fistulas. This is an area that has not really been discussed very much in the past and I think this will be the first Masterclass where high-flow fistulas will be in the spotlight. New devices and new evidence is emerging, such as which balloons are best in vascular access, which stents, and where and when they should be used. We aim to explore all of this.

Why should physicians attend the CX 2021 Vascular Access sessions and what do you think they might learn?

I think it is imperative that people keep up their education during this pandemic. The way that we work and the way that patient care is delivered has been hugely disrupted, and there are definitely things that we can learn from the last year. With these changes in practice, it is important to find out what has actually happened to those patients that have not been able to have treatment, or their treatment has been altered. We need to make sure that we learn lessons from each other about new and different approaches to vascular access care.

If you had to pick one controversy in the programme to turn the spotlight on, what would that be?

A topic of controversy that is poorly understood is that of high-flow fistulas. This is a really interesting area and one I think will create a lot of debate. As well as defining a high-flow fistula, the session will address a number of key questions: Does a high-flow fistula have cardiovascular risks? Does it have risks in terms of increasing interventions, increasing problems? Why do we need a fistula that runs at high flow when actually you only need a fistula that runs about a litre a minute?

Why is this controversy important to the global vascular community?

We do not really know how to deal with high-flow fistulas. International practice differences exist in cannulation and dialysis provision with some approaches aiming for fistulas to suit the logistics of dialysis rather than best long-term outcomes for the fistula and the patient. I think this session will raise many questions about vascular access in general and stimulate some interesting discussion.


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