Institutional Outcomes Of The Hero Graft With And Without The Use Of The Surfacer ® Inside-out ® Access Catheter System For Late-stage Hemodialysis Access
Michael J. Paisley, MD, Joshua Villarreal, MD, Ehab Sorial, MD, Manuel Garcia-Toca, MD MS, Michael Sgroi, MD.
Stanford University, Palo Alto, CA, USA.
Introduction and Objectives: Central venous occlusion creates a difficult clinical situation for patients requiring hemodialysis access. The Hemodialysis Reliable Outflow (HeRO) Graft (Merit Medical, South Jordan, Utah) provides the central venous stenosis patient a modality to obtain outflow for upper extremity dialysis access, and outcomes have not been described previously. In the scenarios where the central venous system cannot be cannulatedcannulized, the Surfacer device (Merit Medical, South Jordan, Utah) can be used as an adjunct to attain central venous access.
Methods: Patients that underwent HeRO placement with and without central venous access utilizing Surfacer were evaluated retrospectively at a single center over from 2015-2021. Data regarding prior hemodialysis access, complications including thrombosis, perioperative medications, comorbidities, outcomes, and survival were analyzed with T-test and Fisher Exact te
Results: HeRO Grafts were attempted 18 times in 16 patients with 17 (94%) successful placements. In 7 of 18 (39%), the Surfacer system was used to gain access to the central circulation. The mean number of prior hemodialysis accesses and the number of prior catheters was 3.4 and 5.7, respectively. The overall mean duration of primary patency was 161 days, and the 30-day primary patency was 72.2%. The overallOverall duration of secondary patency was 269.2 days, with a mean of 2.38 thrombectomies performed per patient. The overall 1-year survivalSurvival was 60%.
Conclusion: Surfacer assisted versus standard HeRO graft placement demonstrates a high 30-day thrombosis rate. although Ssecondary patency is adequate, although the difference was not significant. A history of prior bilateral accesses negatively impacts HeRO patency. This study was limited by its size. A history of prior bilateral and higher number of accesses negatively impacts HeRO patency The overall mortality in this late-stage hemodialysis patient population is poor.
| Overall N=18 | HeRO Alone N=11 | Surfacer Assisted n=7 | |
| Mean Number of Prior Catheters | 5.7 | 5.18 | 6.57 (p=0.43) |
| Mean Number of Prior HD Access | 3.44 | 3.45 | 3.42 (p=0.9) |
| Prior Bilateral AV access % | 83.3 | 72.7 | 100 (p=0.13) |
| Mean Primary Patency (days) | 161 | 188 | 118.7 (p=0.52) |
| 30-day HeRO patency % | 72.2 | 81.8 | 57.1 (p=0.25) |
| Secondary Patency (days) | 269.2 | 342.8 | 153.7 (p=0.44) |
| 1-year Survival % | 60 |
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