Retrospective Chart Review of Patients Who have Undergone Alteration of the HeRO Dialysis Graft
John Perry, David Hardy, MD, Shvetank Agarwal, MBBS, Gautam Agarwal, MD.
Medical College of Gerogia at Augusta University, Augusta, GA, USA.
Objective
Chronic hemodialysis patients who have exhausted multiple accesses or have central venous occlusion are often left catheter dependent, a condition associated with high morbidity and mortality. The HeRO graft has provided means for access in these types of patients, but requires several weeks for maturation before attempted cannulation leaving patients to receive hemodialysis through catheters in the interim. Modifying the HeRO dialysis graft with ACUSEAL graft can allow immediate cannulation and reduction in catheter dependence time. The outcomes and success of this modification have not been fully studied or established.
Methods
A retrospective chart review of patients at our institution from January 2013 to April 2016 who underwent placement and modification of the HeRO dialysis system with ACUSEAL graft was performed. Patient demographics, access history, clinical background, perioperative parameters, complications and outcomes were analyzed. Majority of the data were described by counts, ranges and means when relevant. Primary and secondary patency rates were analyzed, as well as hours to successful cannulation.
Results
HeRO graft with modification of the arterial component using ACUSEAL graft was successfully placed in 10 patients over three years who were catheter dependent. Average follow-up after successful implant has been 15.6 months. The primary reasoning for placement of all HeRO grafts were for central venous occlusions and need for hemodialysis arteriovenous access. The mean time to cannulation of the graft was 33.7 hrs with 100% success. Post-operative complications included two thromboses and one hematoma. One thrombosis was in the immediate postoperative period that required repositioning of the graft and thrombectomy. At a mean follow – up of 6 months, the primary patency rate was 70% and secondary patency rate of 90%, respectively. One patient at 1.7 months required excision of the HeRO dialysis system due a primary infection of the graft.
Conclusion
Central venous occlusions and exhausted arteriovenous access are common complications in the chronic hemodialysis population. HeRO graft placement is able to provide a means of access in these patients who otherwise would be left catheter dependent. Our institution’s method of using ACUSEAL graft for immediate cannulation allows for an accelerated use of this system, reducing catheter dependence time. With few postoperative complications and comparable patency rates, our modification appears to be both safe and efficacious in enabling early cannulation.
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