HeRO Grafts in Dialysis: Techniques, Challenges & Solutions

[Dr. Jason Wagner]
The best way I can describe a HeRO, it stands for Hemodialysis Reliable Outflow. The idea of reliable outflow hemodialysis, some would say that's a misnomer. It's like never event, it's not a thing. With HeRO, it is. The best way to describe it and the way I tell my patients, I say, "Think back to like the '60s or the '70s or whatever they last manufactured the El Camino. It's a pickup truck in the back and it's a car in the front. It's like a pickup car."

The HeRO, it's a graft by the arterial anastomosis. It's a graft up the arm, but then instead of plugging into the vein, it clicks in with a very sleek titanium connector into what basically is a 20 French stent that's embedded inside of a silastic, like a silicone tube. Basically, it's the best aspects of both a graft where it could be inserted quickly and used quickly. It's a suture arterial anastomosis, but then you're skipping beyond the entire axillary and subclavian segment, and pry straight to the jugular and straight down to the SVC and the caper atrial junction.

The nice thing is you're getting a good large border catheter for your outflow, and you have a graft component immediately available to be cannulated in a couple of weeks if you're using a standard graft or if you use the Super HeRO, which is even better branding.