HeRO (Hemodialysis Reliable Outflow) graft alkalmazása                     tartós hemodialíziskezelés során

Abstract: Creating durable vascular access has become more complicated with the improvement of the management and with the increasing survival of patients with end-stage renal disease. HeRO (Hemodialysis Reliable Outflow) graft allows to maintain vascular access on the upper limb in patients with the presence of bilateral central venous occlusion. Our institute was the first in Hungary to perform a HeRO graft implantation in a patient receiving regular hemodialysis. Our objective was to present our findings with this recent innovation. Case report, medical documentation and imaging studies were reviewed. The patient (73-year-old, female) has been receiving hemodialysis since 12 years with the history of several arteriovenous fistula (AVF) creations, thrombectomies, use of central venous catheter in both sides. Following the occlusion of a left cubital arterio-venous fistula, none of the conventional vascular access types could have been performed due to bilateral subclavian vein occlusion. Successful HeRO graft implantation was performed. The patient underwent graft thrombectomy and endovascular intervention 7 and 12 months after the original procedure. After both reoperations, the graft functioned well for hemodialysis. HeRO graft can be a good alternative to central venous catheters and lower limb arterio-venous grafts in cases of bilateral central venous occlusion. Orv Hetil. 2019; 160(31): 1231–1234.

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Hemodialysis Reliable Outflow graft: A valid option in patients with central venous stenosis

The Journal of Vascular Access ◽

10.1177/1129729820917255 ◽

2020 ◽

Vol 21 (6) ◽

pp. 1023-1028

Author(s):

Ana Carolina Figueiredo ◽

Filipe Mira ◽

Luís Rodrigues ◽

Emanuel Ferreira ◽

Nuno Oliveira ◽

...

Keyword(s):

Vascular Access ◽

Venous Catheter ◽

Iliac Vein ◽

Lower Limbs ◽

Implantation Technique ◽

Central Venous ◽

Vein Thrombosis ◽

Central Venous Stenosis ◽

Venous Stenosis ◽

Outflow Graft

Introduction: Central venous stenosis can be the main obstacle to the creation of an autologous vascular access in the upper limbs. The Hemodialysis Reliable Outflow graft was developed to provide an upper limb vascular access option to such patients, avoiding alternative, less advantageous options, such as lower limb vascular accesses or central venous catheters. Its advantages include catheter avoidance and, in case of lower limbs accesses, reduction of the ischemic risk and iliac vein thrombosis, potentially compromising a future kidney transplant. Patients and methods: Revision of the clinical files of the four patients who were placed a Hemodialysis Reliable Outflow device in our Center, including demographic variables, implantation technique characteristics, surgical complications, episodes of infection and thrombosis of the access, and need to place a transitory central venous catheter to undergo hemodialysis treatment. Results: Four Hemodialysis Reliable Outflow grafts were placed, which resulted in a significant improvement in the dialysis efficacy in all patients, with a median raise in the Kt/V of 36.7%. Two cases needed thrombectomy, one of which was unsuccessful. The actual time of patency varies between 3 and 28 months. Conclusion: Our experience with the Hemodialysis Reliable Outflow device showed that it was a safe option for patients with central venous stenosis and was associated with good clinical and analytic outcomes.

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Aneurysm of Arteriovenous Fistula in Uremic Patients: Is Endograft a Viable Therapeutic Approach?

The Journal of Vascular Access ◽

10.1177/112972980200300207 ◽

2002 ◽

Vol 3 (2) ◽

pp. 85-88 ◽

Cited By ~ 16

Author(s):

P.M. Allaria ◽

E. Costantini ◽

A. Lucatello ◽

E. Gandini ◽

F. Caligara ◽

...

Keyword(s):

Central Venous Catheter ◽

Arteriovenous Fistula ◽

Vascular Access ◽

Venous Catheter ◽

Good Alternative ◽

Central Venous ◽

Arteriovenous Fistulas ◽

Risk Of Rupture ◽

Arterial Aneurysms ◽

Percutaneous Insertion

One of the complications of arteriovenous fistulas in chronic hemodialyzed patients is the onset of an aneurysm which can be at risk of rupture. Traditional surgical repair is not always feasible and may not be successful in these cases, leading therefore to the loss of a functioning vascular access and requiring in any case the temporary use of a central venous catheter to allow regular hemodialysis sessions. We applied to this kind of aneurysm the same experience developed in the management of major arterial aneurysms and we considered endografting repair a good alternative in this case. In this paper we present the successful treatment of an arteriovenous fistula aneurysm using that technique. A distal radio-cephalic arteriovenous fistula in one of our patients presented an aneurysm with high risk of rupture. The endografting repair with percutaneous insertion of a Wallgraft™ endoprosthesis was well tolerated and the vascular access could be used the day after, without the need for a central venous catheter insertion.

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Vascular access via translumbar Hemodialysis Reliable Outflow dialysis catheter in a case of severe central venous occlusion

The Journal of Vascular Access ◽

10.1177/1129729818762972 ◽

2018 ◽

Vol 19 (4) ◽

pp. 410-411 ◽

Cited By ~ 1

Author(s):

Anatoly Loskutov ◽

Atman Dave ◽

Christie Gooden ◽

Nathan A Saucier ◽

Kenneth H Cho ◽

...

Keyword(s):

Vascular Access ◽

Venous Occlusion ◽

Dialysis Catheter ◽

Central Venous ◽

Central Venous Occlusion

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Abstract No. 97: Evaluation of a two-stage approach for insertion of the hemodialysis reliable outflow (HeRO) vascular access device in patients with central venous occlusion

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2011.12.137 ◽

2012 ◽

Vol 23 (3) ◽

pp. S42 ◽

Cited By ~ 1

Author(s):

C.B. Looney ◽

P.J. O'brien ◽

S.M. Gage ◽

D.R. Sopko ◽

M.J. Miller ◽

...

Keyword(s):

Vascular Access ◽

Venous Occlusion ◽

Central Venous ◽

Two Stage ◽

Access Device ◽

Central Venous Occlusion ◽

Vascular Access Device

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PS178. Expanded Use of the Hemodialysis Reliable Outflow (HeRO) Vascular Access Device for Permanent Dialysis Access in Patients with Total Central Venous Occlusion

Journal of Vascular Surgery ◽

10.1016/j.jvs.2011.03.146 ◽

2011 ◽

Vol 53 (6) ◽

pp. 76S

Author(s):

Patrick J. O'Brien ◽

Charles Y. Kim ◽

Shawn M. Gage ◽

Jeffrey H. Lawson

Keyword(s):

Vascular Access ◽

Venous Occlusion ◽

Dialysis Access ◽

Central Venous ◽

Access Device ◽

Central Venous Occlusion ◽

Vascular Access Device

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Vascular Access Flow Reduction for Arteriovenous Fistula Salvage in Symptomatic Patients with Central Venous Occlusion

The Journal of Vascular Access ◽

10.5301/jva.5000020 ◽

2011 ◽

Vol 13 (2) ◽

pp. 157-162 ◽

Cited By ~ 40

Author(s):

William C. Jennings ◽

Gregg A. Miller ◽

M. Zachary Coburn ◽

C. Anthony Howard ◽

Michael A. Lawless

Keyword(s):

Arteriovenous Fistula ◽

Vascular Access ◽

Venous Occlusion ◽

Central Venous ◽

Flow Reduction ◽

Central Venous Occlusion

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Central Venous Occlusion in End-Stage Renal Failure—A Rare Mimic of Dural Arteriovenous Fistula (DAVF)

Journal of Stroke Medicine ◽

10.1177/25166085211016647 ◽

2021 ◽

Vol 4 (1) ◽

pp. 81-83

Author(s):

Sharath Kumar Goddu Govindappa ◽

Lakshminarayanapuram Gopal Viswanathan ◽

Shashidhar Kallappa Parameshwarappa ◽

Naveen Nayak ◽

Sujit Kumar ◽

...

Keyword(s):

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Rare Complication ◽

Venous Occlusion ◽

Venous Hypertension ◽

Brachiocephalic Vein ◽

Central Venous ◽

Av Fistula ◽

Central Venous Occlusion ◽

End Stage

Intracerebral hemorrhage is a devastating form of stroke and is more common in patients with hypertension and renal disease. We present the case of a lady suffering from chronic kidney disease who presented with severe headache and aphasia. On evaluation, she was found to have an intraparenchymal hemorrhage in the left temporal lobe with prominent pial and dural veins suggestive of a dural arteriovenous fistula (DAVF). Subsequently, she was detected to have occlusion of the left brachiocephalic vein (LBCV), which resulted in venous hypertension and resulted in this rare complication. Angioplasty followed by stenting of the LBCV resulted in subsidence of her symptoms. We wish to highlight this unusual but treatable complication of limb AV fistula which can mimic intracranial DAVF.

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