The novel use of the Haemodialysis reliable outflow graft (HeRo^®) in intestinal failure patients with end-stage vascular access

Abstract

Intestinal failure (IF) patients are dependent on central venous access to receive parenteral nutrition. Longstanding central venous catheters are associated with life-threatening complications including infections and thromboses resulting in multiple line exchanges and the development ofprogressive central venous stenosis or occlusion. The Haemodialysis Reliable Outflow (HeRO) graft is an arterio-venous device that has been successfully used in haemodialysis patients with ‘end-stage vascular access’. We describe a case series of HeRO graft use in patients with IF and end-stage vascular access. Four HeRO grafts were inserted into IF patients with end-stage vascular access to facilitate or support intestinal transplantation. In all patients the HeRO facilitated immediate vascular access, supporting different combinations of parenteral nutrition, intravenous medications, fluids or renal replacement therapy with no bloodstream infections. In a highly complex group of IF patients with central venous stenosis/occlusion limiting conventional venous access or at risk of life-threatening catheter-related complications, a HeRO® graft can be a feasible alternative.

Injerto HeRO®, una alternativa híbrida para pacientes en hemodiálisis

“…En otro escenario donde el HeRo® ha mostrado utilidad es en los pacientes con insuficiencia intestinal que dependen del acceso venoso central para recibir nutrición parenteral, se ha visto que los catéteres venosos centrales de larga duración se asocian con complicaciones potencialmente mortales, incluidas infecciones y trombosis que dan lugar a múltiples intercambios de líneas y al desarrollo de estenosis u oclusión venosa central progresiva, las cuales limitan el acceso venoso convencional o aumentan el riesgo de complicaciones relacionadas con el catéter y amenazan la vida. Por ello, se ha encontrado que intervenir más temprano, antes del desarrollo de la patología venosa central con la formación de un acceso periférico arteriovenoso, puede reducir las infecciones del torrente sanguíneo asociadas al catéter, ayuda a evitar la patología central y a preservar el acceso venoso, al tiempo que facilita la administración de nutrición parenteral de una manera más eficiente que catéteres centrales tunelizados tradicionales [30].…”

Difficult Vascular Access in Children with Short Bowel Syndrome: What to Do Next?

“…Historically, the use of surgical arteriovenous fistulas like those used for hemodialysis has been reported in adult patients to deliver total parenteral nutrition [46]. More recently, the approach gained some popularity, and its use has been proposed in adults needing long-term TPN [47]. The authors advocate a good patency rate and the need to explore this technique in patients with expiration of vascular real estate despite some procedure-specific complications such as cardiac overload.…”