Prior to the recent Vascular Access Society of the Americas (VASA) Vascular Access for Hemodialysis Symposium (16–18 May, Atlanta, USA), Renal Interventions spoke to William Jennings (OU Health-University of Oklahoma Medical Center, Tulsa, USA) about being chosen as this year’s speaker for the Henry Lecture. During his lecture, Jennings planned to draw attention to his work with Bridge of Life’s (BOL) medical missions, which are focused on chronic kidney disease (CKD) treatment and prevention in developing countries.
Could you outline the premise of the Henry Lecture and also your work with BOL and its vascular access missions?
VASA, much like the European Vascular Access Society (VAS), was founded to combine all the different specialties that are involved in vascular access. Outcomes are clearly much better when you have association with the different specialties and cooperation between them. Mitchell L Henry (The Ohio State University Wexler Medical Center, Columbus, USA) was one of the founders of VASA. He was the third president of the organisation and has been very active in kidney disease, transplantation and vascular access throughout his career. The Henry Lecture was started to honour him for his decades of patient care, teaching and research in the field. Previous examples of past Henry Lectures have featured nephrologists, interventional nephrologists, basic scientists, allied healthcare personnel and surgeons, so it’s a broad range of individuals invited to give this lecture.
I’ve been involved with BOL vascular access surgical efforts since the original vascular access surgical mission in 2012. BOL is a not-for-profit organisation with over 220 missions since its inception in 2006. The surgical missions started in Jamaica, and we’ve now completed over 1,000 vascular access operations in several localities. We have also had many missions for paediatric vascular access in Guatemala City, and it has been particularly rewarding to be involved with all those kids.
We published our experience with children in Guatemala a few years ago, which looked at our first three years of data and we are now preparing our eight-year data to look at teaching with surgical graded responsibility among a group of paediatric surgeons in Guatemala City. We’ve also had missions in other areas of Guatemala for adults, and we’re starting a new mission programme in Guatemala City for adults. There is a lot going on with BOL and we have had good results in Jamaica with a markedly improved fistula rate. Several local surgeons have become skilled vascular access surgeons with good results.
What do you think has been the main thing you have taken back to your own practice from these missions?
I have been involved with teaching surgery and research efforts for 45 years now at the University of Oklahoma in Tulsa with my own practice and with residents and fellows, so we extend that educational experience into our missions. The surgeons who go with us on these mission trips are all educators, they’re all experienced in teaching vascular access surgery, they’re all competent and very skilled in ultrasound, preoperative diagnosis and postoperative care. We also have didactic teaching at these centres besides hands-on graded responsibility and surgical learning. We have been invited to go to each location by the nephrology and surgery groups that recognise the need for something other than catheter dialysis access. We have pre-mission conferences and consultation with them to understand where they stand and how we can best help them.
What do you think are obstacles for vascular access that are more prevalent on a global level?
The places we visit on these missions have very different challenges; some have more resources, some have less. As an example, when we were first invited to work in Guatemala with children, they had very skilled paediatric surgeons and a peritoneal dialysis programme. They also had a functioning transplant department. They just had no experience in vascular access creation. All their dialysis catheters were placed in the subclavian position without ultrasound. We were able to help them get an ultrasound machine—facilitated with Alexandros Mallios (Hôpital Paris Saint-Joseph, Paris, France)—and teach them how to use that for placing catheters via the internal jugular vein and for vessel mapping to plan vascular access operations. Then, over two or three of the first missions, we advanced their surgeons from being assistants to the primary surgeon. So it’s a process, rather than a single visit. That also reflects our experience in Jamaica. We have now been going there for 14 years, to different localities and different hospitals—including the University Hospital of the West Indies— and we’ve watched individual surgeons who were just out of residency move into becoming attending physicians and they have become skilled in vascular access. That’s our primary goal; to establish those local surgeons where they have the skills and the abilities to create the best access, deal with any complication that might arise and understand how to fix a dysfunctional fistula.
Looking forward, what is one goal that you have for the future of these missions?
The University Hospital in Kingston, Jamaica, has established a specific surgical vascular access clinic with two experienced surgeons and resident physicians. There is a surgeon we have trained in access in Mandeville with reliable arteriovenous fistula (AVF) skills, and on the western side of Jamaica, we worked many years with a very skilled surgeon, but their main hospital has been closed for several years and they have a large AVF backlog. Our upcoming mission will be to work with him again and help with the large number of patients who need access in the Montego Bay region of the island. In Guatemala, we’re initiating a mission programme for a new adult access programme. The catheter rate is very high in the adult group and we’re going to extend our children’s AVF effort into these adult patients in Guatemala City. We are also starting a visiting surgeon programme with the first surgeon from Honduras—who will spend a week with us in Guatemala City doing paediatric access. Those are some examples of where we’re headed.
What is it that you’re hoping the audience at VASA will take away from this lecture?
I think the main thing I hope will come from this lecture is that other people will start individual programmes in other areas. One of our colleagues who was a fellow here in Tulsa, Alexandros Mallios, has started vascular access procedures in some of the French islands off Eastern Africa, expanding more efforts for new access training. One thing that VASA attendees will see in my lecture is the huge numbers of untreated and underserviced individuals throughout the world; it’s a giant area that cries out for help.
