Transcript HeRo vs Thigh Fistula

Fewer HeRO Grafts and
More Transposed
Femoral Vein Fistulas
Our Changing Approach to Management
Of Bilateral Central Venous Stenosis
Eric Ladenheim MD
Ladenheim Dialysis Access Centers
12 OF 33
HERO IN
STRAIGHT
CONFIG
21 OF 33
HERO IN
LOOP
CONFIG
HERO GRAFT PRIMARY AND SECONDARY PATENCIES
90% 1 year secondary patency rate
25% 1 year
primary
patency rate
9 SUPERFICIAL
FEMORAL
ARTERYTRANSPOSED
FEMORAL VEIN
THIGH
FISTULAS
61 y/o woman with
HeRO complicated by
excessive ultrafiltration.
Hx Bladder CA
Difficulties with our first
SFA-tFV thigh fistula
Occult lliac vein occlusion
in our first SFA-tFV fistula
Our Workup for SFA-tFV Fistula
• All 9 Patients had palpable pulses
preoperatively
• Duplex assessment of Superficial
femoral vein size and patency
• Contrast venography (8/9) to verify
adequate venous runoff
Complications
Complications
Complications
CANNULATIONS IN THIGH FISTULA PATIENTS
Cannulated Patients
5
4.5
6
4
3.5
3
2.5
2
1
1.5
2
1
0.5
0
Cannulated
Not yet cannulated
Never cannulated
DAYS TO CANNULATION
NO SIGNIFICANT DIFFERENCE BETWEEN GROUPS
HERO GRAFTS
THIGH FISTULAS
AVG. PATIENT AGE
58
57
MALE/FEMALE RATIO
42% MALE / 58%
FEMALE
55% MALE / 45%
FEMALE
DIABETIC PATIENTS
39%
44%
FOLLOW UP INFORMATION
HERO GRAFT
THIGH FISTULAS
MEDIAN FOLLOW UP
TIME (IN DAYS)
117
56
RANGE OF FOLLOW
UP (IN DAYS)
1-761
21-207
CUMULATIVE PRIMARY PATENCY
FEWER HERO GRAFTS & MORE THIGH FISTULAS
14
14
HeRO graft
12
Thigh
fistulas
12
10
8
6
5
4
6
4
0
2
0
1
0
2009
2010
2011
2012
Thigh fistulas
HeRo grafts
Conclusions
• Our Practice has made a significant shift
from HeRO grafts to SFA-tFV thigh fistulas
as our first choice for patients with bilateral
central venous stenosis.
• There has been a significant learning curve
for the SFA-tFV thigh fistula
• Longer follow up needed for proper
comparison between the techniques