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Hemodialysis Reliable Outflow (HeRO) graft creation in upper extremities abandoned due to stent obstruction via recanalization and HeRO outflow component insertion across stent interstices.

Publication ,  Journal Article
Cline, BC; Zuchowski, A; Gage, SM; Martin, JG; Ronald, J; Southerland, KW; Lawson, JH; Dillavou, ED; Kim, CY
Published in: J Vasc Access
December 10, 2021

BACKGROUND: The purpose of this study was to assess the feasibility and outcomes of recanalization and subsequent HeRO graft outflow component insertion across stent interstices in patients with an otherwise abandoned upper extremity. METHODS: Over a 10-year period, 15 patients underwent central venous recanalization by interventional radiology across the interstices of one or more occluded stents for the purpose of subsequent HeRO graft creation. A tunneled central venous catheter was left across the stent and occlusions with tip in right atrium. On a later date, the catheter was used for rapid guidewire access for HeRO graft implantation in the OR by vascular surgery. Procedural and clinical outcomes were determined by retrospective review. Primary and secondary HeRO graft patency rates were estimated with the Kaplan-Meier technique. RESULTS: The technical success rates of recanalization across stent interstices was 100% (15/15). Between one and four overlapping stent walls were traversed. The technical success of the patients who underwent attempted HeRO graft implantation with outflow component traversing across stent interstices was 91% (11/12). No major complications were encountered with either recanalization or HeRO graft implantation. The primary and secondary HeRO patency rates at 12 months were 64% and 80%, respectively. CONCLUSION: HeRO graft insertion across stent interstices is feasible and can provide effective permanent AV access; thus, the presence of stents across the subclavian and brachiocephalic veins should not be considered a contraindication.

Duke Scholars

Published In

J Vasc Access

DOI

EISSN

1724-6032

Publication Date

December 10, 2021

Start / End Page

11297298211048061

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • 4205 Nursing
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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Cline, B. C., Zuchowski, A., Gage, S. M., Martin, J. G., Ronald, J., Southerland, K. W., … Kim, C. Y. (2021). Hemodialysis Reliable Outflow (HeRO) graft creation in upper extremities abandoned due to stent obstruction via recanalization and HeRO outflow component insertion across stent interstices. J Vasc Access, 11297298211048060. https://doi.org/10.1177/11297298211048061
Cline, Brendan C., Adam Zuchowski, Shawn M. Gage, Jonathan G. Martin, James Ronald, Kevin W. Southerland, Jeffrey H. Lawson, Ellen D. Dillavou, and Charles Y. Kim. “Hemodialysis Reliable Outflow (HeRO) graft creation in upper extremities abandoned due to stent obstruction via recanalization and HeRO outflow component insertion across stent interstices.J Vasc Access, December 10, 2021, 11297298211048060. https://doi.org/10.1177/11297298211048061.
Cline BC, Zuchowski A, Gage SM, Martin JG, Ronald J, Southerland KW, Lawson JH, Dillavou ED, Kim CY. Hemodialysis Reliable Outflow (HeRO) graft creation in upper extremities abandoned due to stent obstruction via recanalization and HeRO outflow component insertion across stent interstices. J Vasc Access. 2021 Dec 10;11297298211048060.

Published In

J Vasc Access

DOI

EISSN

1724-6032

Publication Date

December 10, 2021

Start / End Page

11297298211048061

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • 4205 Nursing
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology