Legeza Péter, Garbaisz Dávid, Szeberin Zoltán, Sótonyi Péter
Városmajori Szív- és Érgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Városmajor u. 68., 1122.
Orv Hetil. 2019 Aug;160(31):1231-1234. doi: 10.1556/650.2019.31450.
Creating durable vascular access has become more complicated with the improvement of the management and with the increasing survival of patients with end-stage renal disease. HeRO (Hemodialysis Reliable Outflow) graft allows to maintain vascular access on the upper limb in patients with the presence of bilateral central venous occlusion. Our institute was the first in Hungary to perform a HeRO graft implantation in a patient receiving regular hemodialysis. Our objective was to present our findings with this recent innovation. Case report, medical documentation and imaging studies were reviewed. The patient (73-year-old, female) has been receiving hemodialysis since 12 years with the history of several arteriovenous fistula (AVF) creations, thrombectomies, use of central venous catheter in both sides. Following the occlusion of a left cubital arterio-venous fistula, none of the conventional vascular access types could have been performed due to bilateral subclavian vein occlusion. Successful HeRO graft implantation was performed. The patient underwent graft thrombectomy and endovascular intervention 7 and 12 months after the original procedure. After both reoperations, the graft functioned well for hemodialysis. HeRO graft can be a good alternative to central venous catheters and lower limb arterio-venous grafts in cases of bilateral central venous occlusion. Orv Hetil. 2019; 160(31): 1231-1234.
随着终末期肾病患者管理水平的提高以及生存率的增加，建立持久的血管通路变得更加复杂。HeRO（血液透析可靠流出道）移植物能够在双侧中心静脉闭塞的患者上肢维持血管通路。我们研究所是匈牙利首个为接受定期血液透析的患者植入HeRO移植物的机构。我们的目的是展示这项最新创新技术的研究结果。我们回顾了病例报告、医疗记录和影像学研究。该患者（73岁，女性）12年来一直接受血液透析，有多次动静脉内瘘（AVF）建立、血栓切除术以及双侧使用中心静脉导管的病史。左侧肘动静脉内瘘闭塞后，由于双侧锁骨下静脉闭塞，无法进行任何传统的血管通路类型。成功植入了HeRO移植物。患者在初次手术后7个月和12个月分别接受了移植物血栓切除术和血管内介入治疗。两次再次手术后，移植物均能良好地用于血液透析。在双侧中心静脉闭塞的情况下，HeRO移植物可以成为中心静脉导管和下肢动静脉移植物的良好替代方案。《匈牙利医学周报》。2019年；160(31): 1231 - 1234。
