Aims and objectives
Hemodialysis Reliable Outflow (HeRO) grafts offer a catheter-sparing alternative for some patients with limited vascular options for hemodialysis.
Although these devices have been described as a means of extending the use of the upper extremity for hemodialysis,
limited data are available about the use and outcomes of HeRO grafts in the lower extremity.
In this case series,
we sought to describe the indications and the outcomes of several patients who underwent lower extremity HeRO grafts at our institution.
Methods and materials
Between January 1,
2011 to June 1,
2016,
a total of 6 patients underwent a successful lower extremity HeRO graft placement at the University of Alabama at Birmingham.
The medical records were reviewed and the relevant information were retrieved from the radiology and dialysis database.
All procedures were performed by one experienced transplant surgeon.
Five of the six procedures were done on an outpatient basis.
Access histories,
comorbidities,
medications,
complications,
and one-year outcomes were evaluated.
Results
All patients in this cohort were black and 2 patients were females.
Two had HeRO grafts in the right thigh; four were on the left.
Common comorbidities included hypertension (67%),
hypotension (50%),
diabetes (67%),
dyslipidemia (67%),
obesity (67%),
and smoking (67%),
Three patients had a functional lower extremity HeRO grafts at one year.
Two patients died within one year (at 220 and 111 days,
respectively); both patients had functional grafts at time of death.
The average number of previous catheters per patient was 5.8 (range...
Conclusion
While lower extremity HeRO graft placement is potentially a viable option in those who have limited vascular options for hemodialysis,
these graft are often complicated by recurrent thrombosis and infection.
Personal information
Ammar Almehmi,
MD,
MPH
Director,
Interventional Nephrology
Assocaite Professor of Medicine and Radiology
University of Alabama at Birmingham
Birmingham,
AL
USA
[email protected]
References
Al Shakarchi J,
Houston JG,
Jones RG,
Inston N.
A Review on the Hemodialysis Reliable Outflow (HeRO) Graft for Haemodialysis Vascular Access.
Eur J Vasc Endovasc Surg. 2015 Jul;50(1):108-13
Glickman MH.
HeRO Vascular Access Device.
Semin Vasc Surg. 2011 Jun;24(2):108-12