fewer hero grafts and more transposed femoral vein fistulas our changing approach to management of...
TRANSCRIPT
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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
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12 OF 33 HERO IN STRAIGHTCONFIG
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21 OF 33 HERO IN LOOPCONFIG
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HERO GRAFT PRIMARY AND SECONDARY PATENCIES
25% 1 year primary
patency rate
90% 1 year secondary patency rate
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9 SUPERFICIAL FEMORAL ARTERY- TRANSPOSED FEMORAL VEIN THIGH FISTULAS
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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
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• 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
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Complications
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Complications
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Complications
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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
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DAYS TO CANNULATION
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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%
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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
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CUMULATIVE PRIMARY PATENCY
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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
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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