[HeRO® graft: technical application and clinical experience in 73 cases]

Area of Science:

• Vascular Surgery
• Nephrology
• Interventional Radiology

Context:

• Chronic dialysis patients face challenges in maintaining functional vascular access due to age, comorbidities, and prior interventions.
• Central venous stenosis or occlusion is a significant risk, particularly with catheter use and cardiological/oncological treatments.

Purpose:

• To evaluate the efficacy and role of the Hemodialysis Reliable Outflow (HeRO®) graft in restoring venous outflow for hemodialysis access.
• To assess the HeRO® graft's utility in preserving upper extremity access and lower extremity vasculature.

Summary:

• The HeRO® graft is an established interventional/surgical procedure for stenosed or occluded venous outflow, with 73 successful implantations at our center since 2013.
• The procedure is low-risk with growing experience; reinterventions for thrombosis occur 2-3 times annually and are technically manageable.
• Combined interventions with the Surfacer® System are possible for superior vena cava occlusions, and early cannulation grafts can be used with the HeRO® graft to avoid temporary dialysis catheters.

Impact:

• The HeRO® graft preserves valuable vascular access in the upper extremities and spares critical lower extremity vessels.
• Despite increasing use, the HeRO® graft is considered a reserve procedure, prioritizing interventional methods and established surgical alternatives like internal jugular vein grafts.