Kim Young, Cui Christina L, Chun Tristen T, Kim Charles Y, Dillavou Ellen D, Cox Mitchell W, Southerland Kevin W
Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
Division of Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC.
J Vasc Surg. 2025 Dec;82(6):2163-2169. doi: 10.1016/j.jvs.2025.08.016. Epub 2025 Aug 21.
Hemodialysis Reliable Outflow (HeRO) graft implantation is performed as a last resort option for hemodialysis access in patients limited by central venous stenosis or occlusion. In this single-center series, we examined the incidence, risk factors, and long-term outcomes of patients with a HeRO graft infection.
Institutional medical records were retrospectively reviewed for all HeRO graft procedures performed from 2014 to 2023. Only index procedures were included in this analysis. The primary outcome of interest was HeRO graft infection. Data were analyzed using Kaplan-Meier, univariable, and multivariate analyses.
Over the 10-year study period, 232 patients underwent index HeRO graft surgery with a median follow-up period of 18.5 months. A total of 57 patients (24.6%) were diagnosed with a HeRO graft infection. The estimated 1- and 3-year incidences of graft infection were 14.9% ± 2.6% and 34.2 ± 4.3%, respectively. The median interval from operation to infection was 0.93 years (interquartile range, 0.16-1.88 years). Patients with graft infection were more frequently female (63.2% vs 46.3%; P = .03). Most patients were treated with complete graft resection and intravenous antibiotics (n = 54 [94.7%]). After the infected graft is removed, a nontunneled catheter is used until the infection has been adequately treated. The most common pathogens were Staphylococcus aureus (n = 12 [21.1%]), polymicrobial cultures (n = 11 [19.3%]), and Staphylococcus epidermidis (n = 8 [14.0%]). Primary patency rates were similar between the groups (1 year, 23.8 ± 5.7% vs 37.1 ± 4.1%; log-rank P = .15). However, secondary patency rates were significantly lower among patients with graft infection at 1 year (47.0 ± 6.7% vs 78.6 ± 3.7%) and 3 years (13.8 ± 4.7% vs 59.1 ± 5.4%) (log-rank P < .0001). The median survival after diagnosis of graft infection was 0.95 years (interquartile range, 0.50-2.18 years). On multivariate analysis, only female sex (hazard ratio, 1.89; 95% CI, 1.08-3.31; P = .026) was independently associated with HeRO graft infection.
The incidence of HeRO graft infection is high and persists for years after the index operation. Patients undergoing HeRO graft implantation should be counseled on the risks and consequences of this complication.
血液透析可靠流出道（HeRO）移植物植入术是因中心静脉狭窄或闭塞而受限的血液透析通路患者的最后选择。在这个单中心系列研究中，我们调查了HeRO移植物感染患者的发生率、危险因素和长期预后。
对2014年至2023年期间进行的所有HeRO移植物手术的机构医疗记录进行回顾性审查。本分析仅纳入初次手术。主要关注的结局是HeRO移植物感染。使用Kaplan-Meier法、单变量分析和多变量分析对数据进行分析。
在10年的研究期间，232例患者接受了初次HeRO移植物手术，中位随访期为18.5个月。共有57例患者（24.6%）被诊断为HeRO移植物感染。移植物感染的估计1年和3年发生率分别为14.9%±2.6%和34.2%±4.3%。从手术到感染的中位间隔时间为0.93年（四分位间距，0.16 - 1.88年）。移植物感染患者中女性更为常见（63.2%对46.3%；P = 0.03）。大多数患者接受了移植物完全切除和静脉内抗生素治疗（n = 54 [94.7%]）。在感染的移植物移除后，使用非隧道式导管直至感染得到充分治疗。最常见的病原体是金黄色葡萄球菌（n = 12 [21.1%]）、多种微生物培养物（n = 11 [19.3%]）和表皮葡萄球菌（n = 8 [14.0%]）。两组之间的初次通畅率相似（1年时，23.8%±5.7%对37.1%±4.1%；对数秩检验P = 0.15）。然而，移植物感染患者在1年（47.0%±6.7%对78.6%±3.7%）和3年（13.8%±4.7%对59.1%±5.4%）时的二次通畅率显著较低（对数秩检验P < 0.0001）。移植物感染诊断后的中位生存期为0.95年（四分位间距，0.50 - 2.18年）。多变量分析显示，仅女性性别（风险比，1.89；95%置信区间，1.08 - 3.31；P = 0.026）与HeRO移植物感染独立相关。
HeRO移植物感染的发生率很高，且在初次手术后数年持续存在。应向接受HeRO移植物植入术的患者告知这种并发症的风险和后果。
