Fewer HeRO Grafts and More Transposed Femoral Vein Fistulas Our Changing Approach to Management Of...
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Transcript of Fewer HeRO Grafts and More Transposed Femoral Vein Fistulas Our Changing Approach to Management Of...
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