Educational Exhibit Abstract No. 272 - Review of the HeRO (hemodialysis reliable outflow) device: a novel approach for hemodialysis

Abstract

Learning Objectives 1. Introduce and describe this relatively novel approach to hemodialysis. 2. Discuss post implantation surveillance and complication management. 3. Emphasis will be placed on the interventional radiologist's role with the HeRO device. Background Over half a million people in the United States suffer from chronic kidney disease requiring either renal transplantation or hemodialysis. When a transplant is unavailable, the currently preferred order of providing hemodialysis access is as follows: arteriovenous fistula, graft and central venous catheter. A recently developed alternative for hemodialysis is the HeRO device which is a hybrid access that incorporates a surgically created arterial graft that is connected to a completely subcutaneous central venous catheter. Clinical Findings/Procedure Details This educational exhibit will introduce and describe this new device for hemodialysis and will review indications and appropriate patient selection, including preprocedural patient evaluation. A clinical case example of a HeRO device implantation will be used to illustrate the procedural steps in successfully implanting the device. An algorithm for appropriate clinical and imaging surveillance, maintenance of device patency and management of post-insertion complications such as graft thrombosis will be reviewed. The potential pitfalls, clinical and technical success rates will also be discussed, followed by a summary of the medical literature regarding the HeRO catheter. Conclusion and/or Teaching Points The HeRO device is intended for patients who have exhausted other means of hemodialysis as a result of failed fistulas and/or grafts or for those patients with poor venous outflow (e.g. proximal venous stenoses/occlusions). On the continuum of the preferred order of providing hemodialysis access, this device falls between dialysis grafts and tunneled catheters. The infection rate and incidence of venous stenoses is lower when using this device, as compared to central venous catheters. Secondary intervention rates are lower than central venous catheters, are equivalent to those of arteriovenous grafts and exceed those associated with AV fistulas.