Abstract No. 141 - Management of central venous stenosis in hemodialysis patients: comparison of outcomes with the Hemodialysis Reliable Outflow (HeRO) graft versus stenting

Abstract

To evaluate outcomes of HeRO graft placement and compare its efficacy to central venous stenting in hemodialysis patients with recalcitrant central venous stenosis. We performed a retrospective review of hemodialysis patients who underwent HeRO graft placement or stenting for central venous stenosis between January 2010 and September 2016. The fraction of patients requiring no further intervention, the post-intervention primary lesion patency and number of interventions per patient year for both groups were analyzed. We identified 29 patients with a total of 30 HeRO graft placement procedures. Two patients with no follow-up information after graft placement were excluded from this study. One patient whose HeRO graft was removed due to infection had a repeat HeRO graft placement. We also identified 14 patients who underwent stenting for their central venous stenosis. At the time of this interim analysis, in the HeRO group, 16/28 (57%) were still patent with no further intervention after the graft placement, with a mean follow-up time of 582 days (± 532). In the stent group, 4/14 (28%) were still patent with no further intervention after stenting, with a mean follow up of 579 days (± 371). Among patients requiring an intervention, mean post-intervention primary lesion patency for the HeRO graft (N = 12) was 479 days versus 332 days for the stent group (N = 10). The average number of interventions per patient year for the HeRo and stent groups were 1.4 and 2.3, respectively. Student’s t-test for post-intervention primary lesion patency and number interventions per year for the two groups showed no statistically significant differences (p-values: 0.115 and 0.401, respectively). For the stent group, mean number of intervention per year for covered stent (N = 4) was 0.43 versus 2.12 for non-covered stent (N = 10). Our preliminary analysis of this ongoing study shows no statistically different outcome in patients treated with the HeRO graft versus stenting for central venous stenosis. HeRO is a viable option for hemodialysis patients with recalcitrant central stenosis who are non-surgical candidates for AV fistula.