Fewer HeRO Grafts and More Transposed Femoral Vein Fistulas Our Changing Approach to Management Of Bilateral Central Venous Stenosis Eric Ladenheim MD.

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Presentation transcript:

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 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 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

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

CANNULATIONS IN THIGH FISTULA PATIENTS 6 12

DAYS TO CANNULATION

NO SIGNIFICANT DIFFERENCE BETWEEN GROUPS

FOLLOW UP INFORMATION

CUMULATIVE PRIMARY PATENCY

FEWER HERO GRAFTS & MORE THIGH FISTULAS

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