Background: Central venous stenosis and occlusion are a major cause of vascular access dysfunction
and failure. The HeRO® Graft provides access for patients with central venous occlusion
who are catheter-dependent or have failing fistulae or grafts by providing reliable
venous outflow directly into the right atrium [Figure 1c and d]. Moreover, when combined
with the use of early cannulation grafts it has the advantage of immediate access
directly after the procedure. We reviewed our experience using the strategy of combining
the use of HeRO graft with early cannulation graft. Method(s): Patients with suspected central venous occlusion or stenosis who are catheter-dependent
or have failing fistulae or grafts were discussed in multi-disciplinary meetings.
Only patients with central venous stenosis or occlusion confirmed by CT or conventional
venogram were included [Figure 1a and b]. Patients with active infection, brachial
artery diameter less than 3 mm, hypercoagulable state and ejection fraction less than
20 were excluded. Result(s): Five hemodialysis patients with history of multiple failed arteriovenous access and
confirmed central venous occlusion were recruited. All patients underwent successful
placement of HeRO graft in combination with early cannulation graft [Figure 1c and
d]. All grafts were accessed within 48 hours. Median follow up was 219 days (range
32 -240 days). No adverse events were noted during the follow up period. HeRO graft
thrombosis occurred in three patients, requiring re-intervention using percutaneous
thrombectomy, primary patency 40%. All five grafts remain patent and functional, secondary
patency 100%. Conclusion(s): HeRO® graft placement can provide vascular access in hemodialysis patients with central
venous occlusion who would otherwise remain catheter dependent. Combining the use
of early cannulation graft with HeRO graft placement can further reduce catheter dependence
and does not appear to impact HeRO graft secondary patency.
