Examining Hemodialysis Reliable Outflow catheter performance and cost in hemodialysis access

Torrent, Daniel J.; Maness, Mandy R.; Kachare, Swapnil D.; Zink, Jill; Haisch, Carl E.; Harland, Robert C.; Morgan, Charles W.; Guyton, Rodney L.; Colomb, Avery G.; Barham, David W.; Katz, E; Stoner, Michael C.

doi:10.1016/j.jss.2014.03.016

Cited by 10 publications

(10 citation statements)

References 12 publications

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“…However, of note was that the re-intervention rate was 2.84 procedures per HeRO vascular access device year, which resulted in a high cost of maintenance ($34,713.63 per patient/year). [ 57 ]…”

Section: Access Options For Placement Of Tdcsmentioning

confidence: 99%

“…The use of the novel HeRO device appears attractive[ 51 52 53 ] for those who fail all other traditional AVF and graft options and should be offered as an alternative to the leg AVG. [ 56 57 ] SRT of occluded veins can also be performed. Bypass surgery is the last resort, if all other options fail.…”

Section: A Systematic Approach To the Vascular Access Sites Of Hemodimentioning

confidence: 99%

See 1 more Smart Citation

Vascular Access for Placement of Tunneled Dialysis Catheters for Hemodialysis: A Systematic Approach and Clinical Practice Algorithm

Pereira

Osiason

Salsamendi

2015

Journal of Clinical Imaging Science

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The role of interventional radiology in the overall management of patients on dialysis continues to expand. In patients with end-stage renal disease (ESRD), the use of tunneled dialysis catheters (TDCs) for hemodialysis has become an integral component of treatment plans. Unfortunately, long-term use of TDCs often leads to infections, acute occlusions, and chronic venous stenosis, depletion of the patient's conventional access routes, and prevention of their recanalization. In such situations, the progressive loss of venous access sites prompts a systematic approach to alternative sites to maximize patient survival and minimize complications. In this review, we discuss the advantages and disadvantages of each vascular access option. We illustrate the procedures with case histories and images from our own experience at a highly active dialysis and transplant center. We rank each vascular access option and classify them into tiers based on their relative degrees of effectiveness. The conventional approaches are the most preferred, followed by alternative approaches and finally the salvage approaches. It is our intent to have this review serve as a concise and informative reference for physicians managing patients who need vascular access for hemodialysis.

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Section: Access Options For Placement Of Tdcsmentioning

confidence: 99%

Section: A Systematic Approach To the Vascular Access Sites Of Hemodimentioning

confidence: 99%

Vascular Access for Placement of Tunneled Dialysis Catheters for Hemodialysis: A Systematic Approach and Clinical Practice Algorithm

Pereira

Osiason

Salsamendi

2015

Journal of Clinical Imaging Science

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“…In contrast to this early data, recent studies have reported conflicting clinical outcomes[18–20]. Torrent et al retrospectively evaluated 41 patients and showed a 6-month and 12 month primary patency rate of 30.4% and 8.4%, respectively[19]. The secondary patency rate at 6 months and 12 months was 81.6% and 53.7%, respectively, requiring 2.84 procedures per HeRO graft[19].…”

Section: Discussionmentioning

confidence: 99%

“…Torrent et al retrospectively evaluated 41 patients and showed a 6-month and 12 month primary patency rate of 30.4% and 8.4%, respectively[19]. The secondary patency rate at 6 months and 12 months was 81.6% and 53.7%, respectively, requiring 2.84 procedures per HeRO graft[19]. These reported patency rates are substantially lower than the 164 patient, multicenter trial that noted a primary and secondary 12 month patency rate of 60% and 90.8%, respectively, with 1.5 procedures required per HeRO graft per year[17].…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary team approach to end-stage dialysis access patients

Kensinger

Brownie

Bream

et al. 2015

Journal of Surgical Research

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Background The Hemodialysis Reliable Outflow (HeRO) access device is a permanent dialysis graft used in patients with central venous obstruction. Given the complexity of care related to end-stage dialysis access (ESDA) patients, a multidisciplinary approach has been employed to achieve operative success of HeRO graft placement. Methods The single-center retrospective review included adult patients that were seen in ESDA clinic who underwent a HeRO graft placement from September 2010 to September 2014 under the care of a team consisting of a nephrologist, an interventional radiologist, and a surgeon. The effectiveness of the multidisciplinary approach was evaluated using outcome variables including successful HeRO graft placement, operative complications, the rate of obtaining central venous access, and advanced endovascular maneuvers performed by interventional radiology to obtain central venous access. Results A multidisciplinary approach has been used in 33 ESDA patients. Access to the right atrium was achieved in 100% of cases. 58% of patients required advanced endovascular maneuvers in the interventional radiology suite in order to obtain central venous access. Successful HeRO graft placement was achieved in 94% (31/33) of the study population. No intra-operative complications were encountered. Median primary and secondary patency rates were 83 (IQR: 45–170) days and 345 (IQR: 146–579) days per HeRO graft placement, respectively. Primary and secondary patency rates at 60 days were 70% (23/33) and 79% (26/33), respectively. Conclusions In this difficult patient population, a multidisciplinary team can provide a unique and collaborative approach to HeRO graft placement in patients with complex central venous outflow obstruction.

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“…The Hemodialysis Reliable Outflow (HeRO) graft (Merit Medical Systems, Inc.) can bypass this central venous stenosis providing patients with an additional upper extremity long-term access option. [1][2][3][4][5][6][7][8][9][10][11][12][13] The HeRO graft was approved by the US Food and Drug Administration (FDA) in 2008 and consists of both a proprietary Arterial Graft Component and a Venous Outflow Component. 1 The Arterial Graft Component consists of a 6-mm-inner-diameter expanded polytetrafluoroethylene (ePTFE) hemodialysis (HD) graft with rings to provide additional support and resist kinking of the graft near the traditional titanium connecter.…”

Section: Introductionmentioning

confidence: 99%

Early cannulation of the Hemodialysis Reliable Outflow graft

et al. 2019

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Objective: In complex dialysis patients, central venous stenosis may preclude additional upper extremity access options. The Hemodialysis Reliable Outflow graft (Merit Medical Systems, Inc.) can bypass this stenosis providing patients with an additional upper extremity long-term access option. We report our experience with early-cannulation Hemodialysis Reliable Outflow grafts and compare them to traditional Hemodialysis Reliable Outflow grafts. Methods: We retrospectively reviewed all patients undergoing Hemodialysis Reliable Outflow graft placement from 1 January 2013 through 15 August 2017 at our institution and compared those undergoing placement of traditional Hemodialysis Reliable Outflow grafts and simultaneous tunneled dialysis catheter insertion to those undergoing Hemodialysis Reliable Outflow graft placement using an early-cannulation Hemodialysis Reliable Outflow graft without a tunneled dialysis catheter. Results: A total of 88 patients had 98 Hemodialysis Reliable Outflow grafts inserted throughout this time period. Of these, 61 (62%) were early-cannulation Hemodialysis Reliable Outflow grafts, while 37 (38%) were traditional Hemodialysis Reliable Outflow grafts. Primary, primary-assisted, and secondary patency rates at 1 year were higher for the traditional Hemodialysis Reliable Outflow graft cohort (53.1% vs 25.2%, p < 0.01; 70.1% vs 30.5%, p < 0.01; and 80.4% vs 55.4%, p = 0.07, respectively). There was no difference in the rate of postoperative hematoma, seroma, pseudoaneurysm formation, steal syndrome, or overall graft thrombosis between the two cohorts. Early-cannulation Hemodialysis Reliable Outflow grafts required earlier reintervention for thrombosis and earlier reintervention for any cause when compared to traditional Hemodialysis Reliable Outflow grafts (146 ± 184 days vs 417 ± 272 days, p < 0.01, and 123 ± 169 days vs 401 ± 311 days, p < 0.01, respectively). Conclusion: In complex dialysis patients, early-cannulation Hemodialysis Reliable Outflow grafts have significantly lower 1-year primary and primary-assisted patency rates and require earlier reintervention to maintain this patency compared to traditional Hemodialysis Reliable Outflow grafts.

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Examining Hemodialysis Reliable Outflow catheter performance and cost in hemodialysis access

Cited by 10 publications

References 12 publications

Vascular Access for Placement of Tunneled Dialysis Catheters for Hemodialysis: A Systematic Approach and Clinical Practice Algorithm

Vascular Access for Placement of Tunneled Dialysis Catheters for Hemodialysis: A Systematic Approach and Clinical Practice Algorithm

Multidisciplinary team approach to end-stage dialysis access patients

Early cannulation of the Hemodialysis Reliable Outflow graft

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