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Salvaging the failed Hemodialysis Reliable Outflow (HeRO) vascular access device: Patterns of failure and therapy
Javier E. Anaya-Ayala, MD, Geraldine J. Chen, BS, Matthew K. Adams, MD, Mitul S. Patel, MD, Farhan G. Ahmed, BS, Jean Bismuth, MD, Eric K. Peden, MD, Mark G. Davies, MD, Joseph J. Naoum, MD.
Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.

Background: Hemodialysis Reliable Outflow (HeRO) (Hemosphere Inc,) Vascular Access Device is a long-term access that can overcome some of the challenges of complex dialysis patients with exhausted traditional peripheral access sites and outflow problems due to central venous occlusive disease (CVOD). Initial studies have demonstrated lower rates of infectious complications compared with tunneled dialysis catheters (TDC) and similar patency to traditional arteriovenous grafts (AVG). Experience with HERO catheter salvage has not been reported. We performed a retrospective evaluation our institutional experience salvaging this device.
Methods: A database of thirty three patients (51% males with mean age of 55 ± 19 years) that underwent implantation of the HeRO device from November 2008 to August 2011 was queried. Data included demographics, anatomic and clinical factors, functional and patency rates were determined. Complications, reinterventions, and other factors influencing outcomes were also examined.
Results: 27 patients had history of arterial hypertension, 14 had type 2 diabetes and 9 coronary artery disease. The primary indication were: Need for access creation in the setting of CVOD with exhausted peripheral sites in thirty two patient; and salvage of an existing and functioning arteriovenous fistula (AVF) in one case. The HeRO device was successfully implanted in all patients (Technical success of 100%), the graft was component was anastomosed in the brachial artery in 32 patients (end to side fashion) and the cephalic vein in one case (end to end). The most common access location for the catheter component was the Internal Jugular vein (27 (81%) patients) followed by subclavian veins in 6 (15 %) and the cephalic vein in one (3%). Complications included 10 cases of graft thrombosis, resolved by percutaneous (7) or open (1) thrombectomies of the graft component) (31%), 4 cases graft removal were required secondary to infection and failure due to thrombosis (12%). The primary patency, assisted primary patency and secondary patency rates at 12 months were 55%, 64% and 64% respectively. 9 (30%) patients died from comorbidities non-related to the access procedure, no documented cases of bacteremia occurred during the follow up period.
Conclusions: HeRO Device is a viable alternative to other complex hemodialysis access solutions in access-challenged patients who otherwise have to rely on TDC; however it is associated with high reinterventions and failure rates 43% of cases.


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