HeRO - The Last Resort Measure - Single Center Series and Review of the Literature

Despite recent improvements in the percentage of AV fistula in use among hemodialysis patients, more than 20% of patients remain dependent on a hemodialysis catheter for vascular access. Therefore, development of a novel device for the dialysis vascular access is critically important to improve the management of dialysis patients. The Hemodialysis Reliable Outflow (HeRO®; CryoLife, Kennesaw, GA) graft is a novel vascular access option that is ideally suited for catheter-dependent patients and those in whom previously functional fistulas and grafts have failed as a result of venous outflow stenoses and/ or occlusions. In this manuscript, we report our initial results of HeRO graft implantation with a review of the reported literature regarding this new vascular access device. HeRO graft placement may provide a last resort vascular access option other than tunneled catheter placement for hemodialysis patients in whom there are no longer traditional upper extremity options. However, careful monitoring for the development of central veins and/or right a trial thrombus is critically important after placement of the HeRO graft.