Samuel N. Steerman, Jason Wagner, Jonathan A. Higgins, Claudia Kim, Aleem Mirza, James Pavela, Jean M. Panneton, Marc Glickman
Eastern Virginia Medical School, Norfolk, VA.
OBJECTIVES: The HeRO (Hemodialysis Reliable Outflow) graft is becoming a recognized alternative to Lower Extremity AV Grafts (LEAVG) as an option for patients who have exhausted traditional upper extremity access; however it is unclear which should be applied preferentially.
METHODS: A retrospective review of LEAVG and HeRO implants from January 2006 to August 2010 was performed. Patient demographics, medical history, procedural data and outcomes were evaluated.
RESULTS: Within the time periods, 62 HeROs were placed in 61 patients and 23 LEAVG were placed in 21 patients. Demographics were similar between the two groups for gender, age, BMI, and race. Average follow-up was 14.6 months. The HeRO patients underwent a mean of 6.4 previous TDCs and 3.1 previous AVG/AVFs. The LEAVG patients underwent a mean of 4.1 previous TDCs and 2.8 previous AVG/AVFs.
The principal difference was a 1-year primary patency of 26% for the HeRO group and 60% for the LEAVG group (p=0.01). The number of interventions to maintain patency was 6.2 per year in the HeRO group and 3.7 per year in the AVG group. (p=0.40)
Secondary patency at 1 year was 61% for the HeRO patients and 66% for the AVG patients (p=0.56). The HeRO group and LEAVG had no difference in infection rate (31% vs. 30%) or mortality rate (33% vs. 21% respectively) at 1 year.
CONCLUSIONS: In access challenged patients, LEAVG and HeRO offer a higher incidence of infection, mortality and loss of patency compared to traditional upper extremity access. The LEAVG offers improved primary patency rate over the HeRO device.
AUTHOR DISCLOSURES: M. Glickman, Nothing to disclose; J. A. Higgins, Nothing to disclose; C. Kim, Nothing to disclose; A. Mirza, Nothing to disclose; J. M. Panneton, Nothing to disclose; J. Pavela, Nothing to disclose; S. N. Steerman, Nothing to disclose; J. Wagner, Nothing to disclose.
Posted April 2012