Shin Jiyoung, Cho Ara, Min Seung-Kee, Ahn Sanghyun
Division of Vascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2025 Jun;108(6):397-401. doi: 10.4174/astr.2025.108.6.397. Epub 2025 Jun 2.
The Hemodialysis Reliable Outflow (HeRO) graft (Merit Medical Systems, Inc.), first approved by the U.S. Food and Drug Administration in 2008, provides an alternative vascular access option for patients with end-stage kidney disease who have exhausted upper extremity arteriovenous (AV) access. The first HeRO graft procedure was performed in South Korea in December 2023. Herein, we describe HeRO graft application in 2 complex vascular access scenarios: (1) establishing a new access pathway for a catheter-dependent patient with bilateral central venous occlusions and (2) bypassing recurrent central venous stenotic lesions to restore the function of a mature AV fistula. Given the potential risks, including thrombosis or infection, careful preoperative planning and meticulous patient selection are essential for optimizing HeRO graft outcomes. Further research is necessary to evaluate the long-term efficacy and complication profile of this technique.
血液透析可靠流出道（HeRO）移植物（美瑞泰克医疗系统公司）于2008年首次获得美国食品药品监督管理局批准，为终末期肾病且上肢动静脉（AV）通路已用尽的患者提供了另一种血管通路选择。首例HeRO移植物手术于2023年12月在韩国实施。在此，我们描述HeRO移植物在2种复杂血管通路情况下的应用：（1）为双侧中心静脉闭塞的导管依赖患者建立新的通路途径；（2）绕过复发性中心静脉狭窄病变以恢复成熟AV内瘘的功能。鉴于存在血栓形成或感染等潜在风险，术前仔细规划和精心选择患者对于优化HeRO移植物的效果至关重要。有必要进行进一步研究以评估该技术的长期疗效和并发症情况。
