What is a HeRO graft?
- A HeRO graft also sometimes referred to as a HeRO catheter is an arterial to venous graft which allows high flow of blood for dialysis. Hero grafts are generally used in patients who have few options for venous access for dialysis.
- If venous outflow tracts are stenosed or narrowed because of prior raft and dialysis catheter placement patients may undergo venoplasty to allow for positioning of the venous component of the graft.
- Hero grafts have an arterial component that attaches to an artery usually on the upper arm. it is then connected to the venous outflow component which has a tip in the veins near the right atrium of the heart. The arterial component and the venous outflow components are connected using a titanium connector which is responsible for attaching the arterial graft component to the venous outflow component.
- Venous outflow component is made of silicon with marker bands at the distal tip to allow for better visualization and positioning in the right atrium. This venous component is inserted in to the internal jugular vein and it advances up into the right atrium. This can be done under ultrasound guidance with fluroscopy to confirm the positioning of the tip of the venous component.
HeRO Graft placement
The placement of hero graft is similar to that of a hemodialysis catheter combined with a graft.
The 90 minute procedure is done under general anesthesia. The central venous outflow component is placed in the central vein using the percutaneous endovascular techniques. This way, the tip is somewhere in mid to upper right atrium.
The titanium connector joins both the components such that the arterial graft lies at the deltopectoral groove. An arterial anastomosis joins the arterial graft to the target artery.
Advantages of HeRO Graft vs Fistula
- Reduction in the incidence of infections by 69 percent as compared to dialysis catheter
- Superior dialysis adequacy with 16% to 32% improved dialysis clearance of toxins and fluids when compared with dialysis catheters
- Patency rates which are significantly better than dialysis catheters and similar to arterio-venous grafts. The reported patency rates are up to 87% at 2 years
- These grafts are thought to be cost saving with a 23% average savings per year compared with dialysis catheter placement and management.
How is a HeRO Graft Accessed for dialysis?
• A light tourniquet may be used to dilate the graft.
• If cannulating toward the arterial anastomosis incision, stay at least the length of the fistula needle from the incision site.
• NEVER cannulate the Venous Outflow Component.
• Cannulate 3” (8 cm) from the Connector incision site to avoid damage to the graft rings.
Frequently Asked Questions
What is a HeRO graft and how does it work?
A HeRO graft, also known as a HeRO catheter, is a medical device used for dialysis in patients with limited venous access. It connects an artery to a vein near the heart, allowing high blood flow needed for effective dialysis. The graft consists of an arterial component and a venous outflow component joined by a titanium connector. The venous component is inserted into the internal jugular vein and extends to the right atrium, facilitating efficient dialysis.
Who is a candidate for a HeRO graft?
Patients who have limited options for venous access due to narrowed or stenosed veins may be candidates for a HeRO graft. This often includes individuals who have had previous dialysis catheters or grafts that have compromised their venous outflow tracts. Before placement, a procedure called venoplasty might be performed to ensure the venous component can be properly positioned.
How is a HeRO graft different from a fistula?
A HeRO graft differs from a fistula in several ways. It reduces infection rates by 69% compared to traditional dialysis catheters and offers improved dialysis effectiveness, with better toxin and fluid clearance. While fistulas connect an artery directly to a vein, the HeRO graft uses a connector to attach an arterial graft to a venous outflow component, achieving a patency rate similar to arterio-venous grafts.
What are the benefits of using a HeRO graft?
HeRO grafts offer several advantages over traditional dialysis catheters. They significantly reduce infection rates and improve dialysis adequacy by enhancing toxin and fluid clearance. The grafts also have better patency rates, with up to 87% patency at two years, and they are cost-effective, saving an average of 23% per year compared to dialysis catheter placement and management.
How is the HeRO graft placement procedure performed?
The HeRO graft placement is a 90-minute procedure performed under general anesthesia. It involves placing the venous component in the central vein using percutaneous endovascular techniques, ensuring its tip is positioned in the right atrium. The arterial component is attached to a target artery, typically in the upper arm, and connected via a titanium connector. Fluoroscopy and ultrasound guide the precise placement of the graft.
How should a HeRO graft be accessed for dialysis?
When accessing a HeRO graft for dialysis, a light tourniquet may be used to dilate the graft. Cannulation should be performed at least 3 inches (8 cm) from the connector incision to avoid damaging the graft rings. It is crucial never to cannulate the venous outflow component directly, as this can lead to complications.
What precautions should be taken during HeRO graft cannulation?
During HeRO graft cannulation, avoid inserting the needle near the venous outflow component to prevent damage. Stay at least the length of the fistula needle away from the arterial anastomosis incision. Proper technique and positioning are vital to maintaining the integrity and function of the graft.