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- Mr. James Gilbert
The HeRO Graft An option for patients with End Stage Vascular Access - - PowerPoint PPT Presentation
The HeRO Graft An option for patients with End Stage Vascular Access - - PowerPoint PPT Presentation
The HeRO Graft An option for patients with End Stage Vascular Access Mr. James Gilbert Consultant Transplant & Access Surgeon Disclosures I have the following potential conflicts of interest to report: I currently hold a consultancy
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- Good Pump Speeds
- Normal Pressures
- Process good volumes
- Excellent Adequacy
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Consuming the ‘venous capital’
RRT journey
- 2 or more lines (tunneled)
- 3 or more fistulae
- AV Graft(s)
- 1-2 Transplants
An increasing access challenge Especially if develop CVS / CVO
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End Stage Vascular Access
‘End stage access is reached when all autologous vein
- ptions and conventional graft and catheter placements
have been exhausted or are not possible and there is the presence of central vein pathology’ (Gilbert VASBI 2014)
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Venous Hypertension
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What could we do?
Leave them on a line (wherever we can place one) Consider a ‘Heroic Intervention’
Any procedure or intervention that seeks to treat or bypass Central Venous Pathology (CVP) to enable:
- Autologous access or grafts to function
- Treatment / prevention of venous hypertension
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Heroic Options:
Use of Lower Limbs Angioplasty / Stenting CVS Atypical / Exotic access / bypass procedures HeRO graft Insertion Surfacer Inside Out Catheter System
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Hemodialysis Reliable Outflow (HeRO)
▪ Treatment option for ESVA patients ▪ Only fully subcutaneous AV access option that offers long term access in CVS ▪ Option for patients with failing AVF or graft due to CVS ▪ Option for the catheter dependent or approaching catheter dependence patient with CVS
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HeRO is a 2 Component Device
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Venous Outflow Component
Braided Nitinol stent Covered with Silicon
“HeRO is a Customizable, Sizeable REMOVABLE stent”
Kink Resistant Crush Resistant
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Arterial Graft Component Venous Outflow Component
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3 TCC’s in 3 years!
- 3 AVF attempts, Right B/C AVF eventually successful
- 18 months venous hypertension (arm, face, tongue, vocal cords!)
- Home Haemo patient, agrophobia, wants to stay that way!
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- Left IJ HeRO
- Necklaced across to right side
- Joined onto Right B/C AVF
- Maintained needling areas
- Instant symptom relief
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Clinical Outcomes
HeRO Graft
Oxford
NA 84.6 % 1.125
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- Super HeRO Adaptor first product of its kind in vascular surgery
- Coupling device that allows for certain grafts to be used with
HeRO Outflow Component
- Avoids graft to graft anastomosis
Adapter
Make your own with Super HeRO
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Closing Comments
ESVA patients increasingly more common Any history / presence of a TCC accelerates ESVA due to Central
Vein Stenosis / Occlusion
The HeRO Graft is the only AV access option that can bypass
CVS and provide reliable dialysis
The Super HeRO adaptor enables direct connection of certain
grafts with the outflow and avoids a graft – graft anastomosis or bridging catheter
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