Document Detail

Report on the Hemodialysis Reliable Outflow (HeRO) experience in dialysis patients with central venous occlusions.
MedLine Citation:
PMID:  23591186     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The Hemodialysis Reliable Outflow (HeRO) graft (Hemosphere/CryoLife Inc, Eden Prairie, Minn) has provided an innovative means to obtain hemodialysis access for patients with severe central venous occlusive disease. The outcomes of this novel treatment modality in a difficult population have yet to be clearly established.
METHODS: A retrospective review of HeRO graft placement from June 2010 to January 2012 was performed. Patient hemodialysis access history, clinical complexity, complications, and outcomes were analyzed. Categoric data were described with counts and proportions, and continuous data with means, ranges and, when appropriate, standard deviations. Patency rates were analyzed using life-table analysis, and patency rate comparisons were made with a two-group proportion comparison calculator.
RESULTS: HeRO graft placement was attempted 21 times in 19 patients (52% women), with 18 of 21 (86%) placed successfully. All but one was placed in the upper extremity. Mean follow-up after successful placement has been 7 months (range, 0-23 months). The primary indication for all HeRO graft placements except one was central vein occlusion(s) and need for arteriovenous access. Patients averaged 2.0 previous (failed) accesses and multiple catheters. Four HeRO grafts (24%), all in women, required ligation and removal for severe steal symptoms in the immediate postoperative period (P < .01 vs men). Three HeROs were placed above fistulas for rescue. All thrombosed <4 months, although the fistulas remained open. An infection rate of 0.5 bacteremic events per 1000 HeRO-days was observed. At a mean follow-up of 7 months, primary patency was 28% and secondary patency was 44%. The observed 12-month primary and secondary patency rates were 11% and 32%, respectively. Secondary patency was maintained in four patients for a mean duration of 10 months (range, 6-18 months), with an average of 4.0 ± 2.2 thrombectomies per catheter.
CONCLUSIONS: HeRO graft placement, when used as a last-resort measure, has been able to provide upper extremity access in patients who otherwise would not have this option. There is a high complication rate, however, including a very high incidence of steal in women. HeRO grafts should continue to be used as a last resort.
Justin R Wallace; Rabih A Chaer; Ellen D Dillavou
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Publication Detail:
Type:  Journal Article     Date:  2013-04-13
Journal Detail:
Title:  Journal of vascular surgery     Volume:  58     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-08-26     Completed Date:  2013-10-28     Revised Date:  2014-04-09    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  742-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
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MeSH Terms
Aged, 80 and over
Arteriovenous Shunt, Surgical / adverse effects,  instrumentation*
Blood Vessel Prosthesis* / adverse effects
Blood Vessel Prosthesis Implantation / adverse effects,  instrumentation*
Catheterization, Central Venous / adverse effects*
Graft Occlusion, Vascular / etiology,  physiopathology
Ischemia / etiology,  physiopathology
Life Tables
Middle Aged
Prosthesis Design
Prosthesis-Related Infections / microbiology
Renal Dialysis*
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Upper Extremity / blood supply*
Upper Extremity Deep Vein Thrombosis / etiology*,  physiopathology
Vascular Patency
Young Adult
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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