1. 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

2. 12 OF 33 HERO IN STRAIGHT CONFIG

3. 21 OF 33 HERO IN LOOP CONFIG

4. HERO GRAFT PRIMARY AND SECONDARY PATENCIES 25% 1 year primary patency rate 90% 1 year secondary patency rate

5. 9 SUPERFICIAL FEMORAL ARTERY- TRANSPOSED FEMORAL VEIN THIGH FISTULAS

6. 61 y/o woman with HeRO 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

7. 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

8. Complications

11. CANNULATIONS IN THIGH FISTULA PATIENTS 6 12

12. DAYS TO CANNULATION

13. NO SIGNIFICANT DIFFERENCE BETWEEN GROUPS

14. FOLLOW UP INFORMATION

15. CUMULATIVE PRIMARY PATENCY

16. FEWER HERO GRAFTS & MORE THIGH FISTULAS

17. 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