In patients with exhausted upper limb options or subclavian vein stenosis is a HeRo device preferable to lower limb access
Hemodialysis Reliable Outflow (HeRO) device in end-stage dialysis access: a decision analysis model. J Surg Res 2012 Sep;177(1):165-71
...Concludes that the HeRo device is lest costly than the thigh Loop with regard to limb ischemia and amputations. But: If you choose Your patients for a thigh loop carefully and always do arterial and venous mapping with regard to peripheral arterial occlusive disease, the thigh loop as a "bio" access should be preferred over a foreign body. Foreign body infections contribute to increased morbidity and mortality in HD patients.
In our experience, an upper extremity access is always preferred over a lower extremity. While leg grafts have acceptable patency rates, they have higher infection rates, are more difficult to cannulate, and are undesirable from a patient standpoint. Plus, we have found that once you abandon the upper extremity for lower extremity and that fails, your options for access are greatly diminished. So, for us, we have gone to using the HeRO in our patients who still have the option for a leg graft, so that we have that fallback option.
I don't understand the point that a leg graft is a "bio" access, as it is essentially the same thing as an arm graft with the hero catheter as outflow - both are foreign. The hero has the advantage that there is no venous anastamosis to become stenotic.
Today I put HeRO grafts in sick, elderly patients who I think will probably die in a year or two and I do femoral vein fistulas (Superficial Femoral Artery to transposed femoral vein) in healthy patients expected to live for several years.
I recently presented a paper "Fewer HeRO Grafts and More Thigh Fistulas: Our Changing approach to Management of Bilateral Central Venous Stenosis". I am working on the manuscript. My presentation is attached.
Eric
- Badges
- Science topic
- Similar topics
- Correction