“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”
The CX 2021 Vascular Access Controversies Programme is designed to showcase the latest advances and disputes in the creation, maintenance and restoration of dialysis access.
One of the most controversial aspects of the programme in April 2021, says Nicholas Inston (Birmingham, UK), CX Executive Board Member, is that of high-flow fistulas. “I think this will be the first Masterclass where high-flow fistulas will be in the spotlight. This is a really interesting area, and it is one, I think, that 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 or problems? Why do we need a fistula that runs at high flow when you actually only need a fistula that runs at about a litre a minute?”. Interestingly, the potentially increased risks from high-flow fistulas might play to the advantage of those created by percutaneous means, which typically show lower flow rates – but pose their own challenges, such as with respect to cannulation.
Why is this 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,” Inston explains.