Early use conversion of the HeRO dialysis graft

Although more challenging to place, the HeRO device (Hemosphere Inc, Eden Prairie, Minn) provides the dialysis access-challenged patient the opportunity to have an upper extremity graft rather than being dependent on a catheter or requiring a lower extremity access. A major difficulty with the HeRO is the need for a concomitant dialysis catheter until the graft matures. This has been associated with a large number of bacteremia episodes. Currently available early-access grafts have patency rates similar to standard polytetrafluoroethylene. We have modified the HeRO insertion technique to combine its attributes with those of an early-use graft. In the five patients presented in this report, we confirm that this new technique can give the patient a graft that is functional ≤72 hours and obviate the need for a concomitant catheter. This results in an infection-free access over the follow-up period.