A Review on the Hemodialysis Reliable Outflow (HeRO) Graft for Haemodialysis Vascular Access

Abstract

This literature review shows that the HeRO graft is an acceptable option for complex dialysis patients who are catheter dependent. Owing to device availability, published data are predominantly North American and further longer-term studies in other populations may be necessary. In this challenging patient group, randomized controlled trials are required to allow comparisons with alternative access options.

From ZeRO to HeRO: Saving lives one HeRO at a time

“…Other complications associated with TDCs such as thrombosis, steal syndrome and ultimately, central venous stenosis and/or occlusion have also been reported to be significantly less for the HeRO graft [4], [6], [7]. Both Al Shakarchi et al and Katzman et al noted low incidences of steal syndrome with percentages reported as 6.3% and 2.6% respectively [4], [7].…”

“…A review of the literature suggests that rates of infection and bacteraemia associated with the HeRO graft are significantly less than those associated with TDCs and consequently, the rates of associated mortality are also less. A systematic review of the literature by Al Shakarchi et al report device related bacteraemia (per 1000 days) of 0.13-0.7 and HeRO graft infection in just 10.1% (2.5–21%) [4]. When compared with the reported catheter-related incidences, it is evident that these values are significantly lower for the HeRO graft than they are for TDCs.…”

“…The number of dialysis patients outliving their arteriovenous (AV) access is also increasing [3]. As such, clinicians are presented with the challenge of providing these patients with alternative, definitive AV access for ongoing, successful haemodialysis [4].…”

“…Although only recently introduced for use in Europe, early studies suggest that the rate of complications associated with the HeRO graft are significantly less than those associated with the tunnelled dialysis catheter (TDC) [3], [4], [5]. A review of the literature suggests that rates of infection and bacteraemia associated with the HeRO graft are significantly less than those associated with TDCs and consequently, the rates of associated mortality are also less.…”

“…Katzman et al report primary patency rates of 38.9% for the HeRO device, with direct comparison to AV graft patency at 12 months of 42% [7]. Review of the literature by Al Shakarchi et al showed a range of patency rates for the HeRO device of between 9.6% and 37.2% [4].…”