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HeRO catheter for dialysis

John W Perry, David Hardy, Shvetank Agarwal, Gautam Agarwal
Hemodialysis Reliable Outflow (HeRO) grafts (Merit Medical Systems, Inc, South Jordan, Utah) provide a means for access in catheter-dependent hemodialysis patients but typically require several weeks for tissue incorporation. Modifying the HeRO graft with an ACUSEAL graft (W. L. Gore & Associates, Newark, Del) can allow immediate cannulation, thus reducing catheter dependence time and its associated complications. A retrospective review of patients at our institution from 2013 to 2016 who underwent placement of a modified HeRO dialysis system with ACUSEAL graft was performed...
September 2017: Journal of Vascular Surgery Cases and Innovative Techniques
Dr Charlotte Ratcliff, Miss Monica Hansrani
INTRODUCTION: This case report intends to highlight the Haemodialysis Reliable Outflow (HeRO) graft as a potential long term option for ongoing dialysis in patients with central venous stenosis. PRESENTATION OF CASE: A 55year old patient, who developed end stage renal failure (ESRF) after chemotherapy treatment for breast cancer, presented at the limit of her dialysis access after a 15year haemodialysis history causing central vein stenosis. The patient was initially started on peritoneal dialysis but after repeated peritonitis was switched to haemodialysis...
2016: International Journal of Surgery Case Reports
Kathryn L Davis, John C Gurley, Daniel L Davenport, Eleftherios S Xenos
OBJECTIVES: Hemodialysis (HD) patients with superior vena cava (SVC) occlusion have limited access options. Femoral access is commonly employed but is associated with high complication rates. Hemodialysis Reliable Outflow (HeRO) catheters can be used in tunneled catheter-dependent (TCD) patients who have exhausted other access options. The HeRO graft bypasses occlusion and traverses stenosis with outflow directly into the central venous circulation. At our institution we have used the inside-out central venous access technique (IOCVA) to traverse an occluded vena cava for HeRO graft placement...
March 2016: Journal of Vascular Access
J Al Shakarchi, J G Houston, R G Jones, N Inston
OBJECTIVES: With improved dialysis survival there are increasing numbers of patients who have exhausted definitive access options due to central venous stenosis and are maintaining dialysis on a central venous catheter. The Hemodialysis Reliable Outflow (HeRO) allows an alternative by providing a definitive access solution. The aim of this study is to systematically review the published outcomes of the HeRO graft and discuss the role in complex haemodialysis patients. METHODS: Electronic databases were searched for studies assessing the use of the HeRO graft for dialysis in accordance with PRISMA published up to December 31 2014...
July 2015: European Journal of Vascular and Endovascular Surgery
William J Yoon, David R Lorelli
PURPOSE: To evaluate a two-stage Hemodialysis Reliable Outflow (HeRO) implantation technique that avoids the use of a femoral bridging catheter versus the conventional one-stage technique requiring a bridging catheter in selected patients. METHODS: A retrospective review was performed on 20 end-stage renal disease patients with an internal jugular vein (IJV) catheter selected for two-stage HeRO implantation at our institution between January 2010 and March 2013...
May 2015: Journal of Vascular Access
Daniel J Torrent, Mandy R Maness, Swapnil D Kachare, Jill N Zink, Carl E Haisch, Robert C Harland, Claire Morgan, Rodney L Guyton, Avery G Colomb, David W Barham, Eric C Katz, Michael C Stoner
BACKGROUND: The Hemodialysis Reliable Outflow (HeRO) vascular access device is a hybrid polytetrafluoroethylene graft-stent construct designed to address central venous occlusive disease. Although initial experience has demonstrated excellent mid-term patency rates, subsequent studies have led to external validity questions. The purpose of this study was to examine a single center experience with this vascular access device in challenging access cases with associated costs. METHODS: A retrospective study representing the authors' cumulative HeRO vascular access device experience was undertaken...
November 2014: Journal of Surgical Research
Deirdre Hart, Christie Gooden, L S Cummings, Brandt C Wible, John Borsa, Henry Randall
After creation of an arteriovenous fistula or placement of an arteriovenous graft, several weeks are required for maturation prior to first cannulation. Patients need an alternative way to receive hemodialysis during this time, frequently a catheter. After multiple failed access attempts, patients can run out of options and become catheter dependent. At our institution, we place HeRO grafts in eligible patients who have otherwise been told they would be catheter dependent for life. By combining the HeRO graft system with a Flixene graft, patients are able to remove catheters sooner or avoid placement as they can undergo cannulation for hemodialysis the next day...
2014: TheScientificWorldJournal
Hector Ferral, George Behrens, Yanki Tumer, Sebouh A Gueyikian, Edward F Hollinger, Stephen C Jensik
A modified technique for placement of the venous outflow component (VOC) of the Hemodialysis Reliable Outflow (HeRO) device (Hemosphere Inc, Minneapolis, Minn) is described. The purpose of the technique is to improve the system's trackability and facilitate device insertion in patients with central venous occlusion. Device preparation requires placement of a 6-mm × 4-cm angioplasty balloon within the leading end of the VOC. The leading 2 cm of the balloon are placed just distal to the radiopaque marker of the VOC...
October 2013: Journal of Vascular Surgery
Justin R Wallace, Rabih A Chaer, Ellen D Dillavou
OBJECTIVE: The Hemodialysis Reliable Outflow (HeRO) graft (Hemosphere/CryoLife Inc, Eden Prairie, Minn) has provided an innovative means to obtain hemodialysis access for patients with severe central venous occlusive disease. The outcomes of this novel treatment modality in a difficult population have yet to be clearly established. METHODS: A retrospective review of HeRO graft placement from June 2010 to January 2012 was performed. Patient hemodialysis access history, clinical complexity, complications, and outcomes were analyzed...
September 2013: Journal of Vascular Surgery
Thomas A Gebhard, Joshua A Bryant, J Adam Grezaffi, Waleska M Pabon-Ramos, Shawn M Gage, Michael J Miller, Kurt W Husum, Paul V Suhocki, David R Sopko, Jeffrey H Lawson, Tony P Smith, Charles Y Kim
PURPOSE: To determine the outcomes of percutaneous interventions for prolonging the patency of the Hemodialysis Reliable Outflow (HeRO) device. MATERIALS AND METHODS: Between January 2007 and August 2011, 73 percutaneous interventions were performed on 26 HeRO devices in 25 patients. The graft was implanted in the upper arm with the outflow catheter tip in the superior vena cava or right atrium. Procedural reports, angiographic images, and clinical notes were retrospectively reviewed...
April 2013: Journal of Vascular and Interventional Radiology: JVIR
Samuel N Steerman, Jason Wagner, Jonathan A Higgins, Claudia Kim, Aleem Mirza, James Pavela, Jean M Panneton, Marc H Glickman
OBJECTIVE: The Hemodialysis Reliable Outflow (HeRO) graft is becoming a recognized alternative to lower extremity arteriovenous grafts (LEAVGs) as an option for patients who have exhausted traditional upper extremity access; however, which should be applied preferentially is unclear. METHODS: A retrospective review of LEAVG and HeRO implants from January 2004 to August 2010 was performed. Patient demographics, medical history, procedural data, and outcomes were evaluated...
March 2013: Journal of Vascular Surgery
Leigh Anne Dageforde, Peter R Bream, Derek E Moore
BACKGROUND: The Hemodialysis Reliable Outflow (HeRO) dialysis access device is a permanent tunneled dialysis graft connected to a central venous catheter and is used in patients with end-stage dialysis access (ESDA) issues secondary to central venous stenosis. The safety and effectiveness of the HeRO device has previously been proven, but no study thus far has compared the cost of its use with tunneled dialysis catheters (TDCs) and thigh grafts in patients with ESDA. MATERIALS AND METHODS: A decision analytic model was developed to simulate outcomes for patients with ESDA undergoing placement of a HeRO dialysis access device, TDC, or thigh graft...
September 2012: Journal of Surgical Research
S M Gage, H E Katzman, J R Ross, S E Hohmann, C A Sharpe, D W Butterly, J H Lawson
OBJECTIVE: To report a multi-center experience with the novel Hemodialysis Reliable Outflow (HeRO) vascular access graft. MATERIALS AND METHODS: Four centers conducted a retrospective review of end stage renal disease patients who received the HeRO device from implant to last available follow-up. Data is available on 164 patients with an accumulated 2092.1 HeRO implant months. RESULTS: At 6 months, HeRO primary and secondary patency is 60% and 90...
July 2012: European Journal of Vascular and Endovascular Surgery
Marc H Glickman
Chronic hemodialysis via a tunneled dialysis catheter (TDC) is associated with a high incidence of infectious complications and increased mortality and, therefore, should only be considered when all other options for vascular access are exhausted. The Hemoaccess Reliable Outflow (HeRO) Vascular Access Device (Hemosphere, Inc., Minneapolis, MN) is an alternative to the TDC. Early results suggests that the infectious complications are significantly less for the HeRO device when compared to the TDC, and the secondary patency for the device approximates that for prosthetic accesses...
June 2011: Seminars in Vascular Surgery
Earl Schuman, Amy Ronfeld
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...
June 2011: Journal of Vascular Surgery
Maureen Fusselman
In order to supplement post-market surveillance data on the HeRO vascular access device, a non-scientific customer survey was conducted to obtain quantitative data from dialysis providers caring for patients implanted with the device. Dialysis nurses involved in the care of HeRO patients were contacted in order to obtain post-implant device performance information for 10% of patients implanted with the device at the time of the survey. Thirty-eight dialysis units with a total of 65 HeRO patients participated in the survey...
August 2010: Nephrology News & Issues
Julio C Vasquez, Jacob DeLaRosa, Fahim Rahim, Naeem Rahim
Patients with central venous occlusion who are ''tunneled catheter dependent'' are a challenge for hemodialysis access. A relatively new option for them is the hemodialysis reliable outflow (HeRO) device that can be totally implanted subcutaneously. However, patients still require a tunneled hemodialysis catheter that is used until the HeRO device is mature, 4 to 6 weeks later. Here, we describe a conversion of an existing tunneled hemodialysis catheter into a HeRO device, which was combined with a ''self-sealing'' Flixene graft...
November 2010: Vascular and Endovascular Surgery
George M Nassar
The Hemodialysis Reliable Outflow (HeRO) Vascular Access Device is a novel long-term subcutaneous dialysis graft, ideally suited for catheter-dependent patients and patients dialyzing with failing fistulas or grafts due to venous outflow stenosis. This case presentation depicts the clinical course of the first patient to enter a Food and Drug Administration approved clinical trial and receive the HeRO device. The course of this patient over 56 months of follow-up provides the longest experience with the HeRO device to-date...
March 2010: Seminars in Dialysis
Howard E Katzman, Robert B McLafferty, John R Ross, Marc H Glickman, Eric K Peden, Jeffery H Lawson
OBJECTIVE: The effects of a new long-term subcutaneous vascular access device were studied in access-challenged patients who were poor candidates for fistulas or grafts due to venous obstruction. Bacteremia rates, patency, and function of the Hemodialysis Reliable Outflow (HeRO) Vascular Access Device (Hemosphere Inc, Minneapolis, Minn) were evaluated. METHODS: The HeRO device consists of a 6-mm expanded polytetrafluoroethylene graft attached to a 5-mm nitinol-reinforced silicone outflow component designed to bypass venous stenoses and enter the internal jugular vein directly, providing continuous arterial blood flow into the right atrium...
September 2009: Journal of Vascular Surgery
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