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Safety And Efficacy Of Hemodialysis Reliable Outflow Graft Implantation On Terminal Access End Stage Renal Diseased Patients
Jordan S. Christopher, DO, Ryan A. Schmelter, DO, Mark A. Mattos, MD.
Michigan Vascular Center, Flint, MI, USA.
OBJECTIVES: To evaluate and report on a single institution’s experience regarding the safety and efficacy of Hemodialysis Reliable Outflow (HeRO) grafts in patients with terminal access end stage renal disease.
METHODS: A retrospective, single center analysis evaluating 94 patients who underwent 97 Hemodialysis Reliable Outflow graft insertions from July 01, 2010 to July 01, 2025. Demographics, patency rates, mortality rates, reintervention rates, and complications were analyzed.
RESULTS: A total of 94 patients underwent 97 Hemodialysis Reliable Outflow graft insertions. Mean age was 64.7 years (range 29-91) with an equal male:female ratio. Eighty nine procedures (94.7%) were performed in the upper extremities with the brachial artery (64.7%) being the most common upper extremity inflow source. The remaining 8 procedures that were performed in the lower extremities utilized only femoral arteries and veins for access. Seventy six patients (78.4%) underwent a staged approach to implantation, while the remaining patients underwent primary insertion. The 30-day mortality was 7.2% (7/97 procedures). For those who survived the perioperative period, the mean follow up was 553.27 days (range 6-3008). At 6, 12, and 24 months, the primary patency rates were 32.8%, 20.9%, and 6.2%, respectively. Primary-assisted patency rates were 51.5%, 34.8%, and 25%, and the secondary patency rates were 89%, 90.6%, and 84.3%. Mortality rates at 6, 12, and 24 months were 19.2%, 41.4%, and 56.32%. An average of 3.3 interventions were performed to maintain patency per year per patient. Post-operative complications included 10 patients (10.3%) who experienced steal syndrome, 6 patients (6.2%) with venous outflow component migration, and 12 patients (12.4%) who experienced graft infection requiring surgical intervention.
CONCLUSIONS: Hemodialysis Reliable Outflow grafts should be considered as a viable option for patients with terminal dialysis access. In the perioperative and short term follow up periods, we experienced a higher than expected mortality rate, which underscores the disease severity and comorbid conditions typically present in this patient population. Despite this, we have shown that with aggressive surveillance and expeditious salvage interventions acceptable HeRO patency and utilization rates may be achieved through 24 months.
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