Early Cannulation of the Hemodialysis Reliable Outflow (HeRO) Graft: A Single Center Experience.
Ahmed Mohamed, M.D., Travis J. Vowels, M.D., Matthew E. Bennett, M.D., Eric K. Peden, M.D.
Houston Methodist Hospital, Houston, TX, USA.
OBJECTIVES: In complex dialysis patients, central venous stenosis may preclude additional upper extremity access options leaving the patient dependent on a catheter or a lower extremity fistula or graft. The Hemodialysis Reliable Outflow (HeRO) Graft (Merit Medical Systems, Inc, South Jordan, UT) can bypass this central venous stenosis providing patients with an additional upper extremity long-term access option. However, patients will still be temporarily dependent on a catheter while the graft matures or is incorporated. The new Super HeRO Adapter and Support Seal system (Merit Medical Systems, Inc, South Jordan, UT) allows the use of early cannulation vascular grafts with the existing HeRO Graft Venous Outflow Component, saving patients valuable catheter dependent days and their associated complications. We report our experience with the early access HeRO Graft.
METHODS: We queried our internal database for all patients undergoing HeRO Graft placement from January 1, 2016 through August 15, 2017 at Houston Methodist Hospital in the Texas Medical Center. Demographic, operative, and surveillance data were collected and analyzed for each patient included in our cohort.
RESULTS: Of the 46 patients undergoing HeRO Graft placement, 35 (76%) had successful cannulation of their HeRO Graft within 72 hours; the majority (n=26, 63%) of patients were cannulated within 24 hours. A Gore Acuseal Vascular Graft (W. L. Gore & Associates, Newark, DE) was used in 45 (98%) of patients and a Flixene Vascular Graft (Maquet Getinge Group, Wayne, NJ) was used in 1 (2%) of patients. Average follow-up was 5.7 months. Primary and secondary patency rates at 6 months in our cohort are 41% and 69%, respectively. Postoperative complications included hematoma in 3 patients (6.5%), thrombosis in 18 (40%), steal syndrome in 3 (6.5%), and graft infection in 3 (6.5%).
CONCLUSIONS: Early cannulation of HeRO Grafts seems to be a feasible option in complex dialysis patients sparing them valuable catheter dependent days and the associated complications. 
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