Fewer HeRO Grafts and More Transposed

Femoral Vein Fistulas

Our Changing Approach to Management Of Bilateral Central Venous Stenosis

Eric Ladenheim MDLadenheim Dialysis Access Centers

12 OF 33 HERO IN STRAIGHTCONFIG

21 OF 33 HERO IN LOOPCONFIG

HERO GRAFT PRIMARY AND SECONDARY PATENCIES

25% 1 year primary

patency rate

90% 1 year secondary patency rate

9 SUPERFICIAL FEMORAL ARTERY- TRANSPOSED FEMORAL VEIN THIGH FISTULAS

61 y/o woman withHeRO complicated by

excessive ultrafiltration.Hx Bladder CA

Occult lliac vein occlusion in our first SFA-tFV fistula

Difficulties with our first SFA-tFV thigh 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

Our Workup for SFA-tFV Fistula

Complications

Complications

Complications

CANNULATIONS IN THIGH FISTULA PATIENTS

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Cannulated Not yet cannulated Never cannulated

Cannulated Patients

6

1 2

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

2009 2010 2011 20120

2

4

6

8

10

12

14

HeRo grafts

12

14

6

10 0

54

Thigh fistulas

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

HeRO graft

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