title: Examining Hemodialysis Reliable Outflow catheter performance and cost in hemodialysis access.
abstract: BACKGROUND
  The Hemodialysis Reliable Outflow (HeRO) vascular access device is a hybrid polytetrafluoroethylene graft-stent construct designed to address central venous occlusive disease. Although initial experience has demonstrated excellent mid-term patency rates, subsequent studies have led to external validity questions. The purpose of this study was to examine a single center experience with this vascular access device in challenging access cases with associated costs.
  
  
  METHODS
  A retrospective study representing the authors' cumulative HeRO vascular access device experience was undertaken. The primary endpoint was graft failure or death, with secondary endpoints including secondary intervention rates and cost.
  
  
  RESULTS
  Forty-one patients with 15,579 HeRO days and a mean of 12.7 ± 1.5 mo with the vascular access device were available for analysis. Secondary patency was 81.6% at 6 mo and 53.7% at 12 mo. The reintervention rate was 2.84 procedures per HeRO vascular access device year. Associated HeRO costs related to subsequent procedures were estimated at $34,713.63 per patient/y.
  
  
  CONCLUSIONS
  These data on the patency and primary outcome data diverge significantly from initial multicenter studies and represent a real-world application of this technology. It is costly to maintain patency. Use of HeRO vascular access devices should be judicious with outcome expectations reduced.
authors.affiliation: Department of Surgery, East Carolina University, Greenville, North Carolina.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Torrent
authors.affiliation: Department of Surgery, East Carolina University, Greenville, North Carolina.
authors.forename: Mandy R
authors.initials: MR
authors.lastname: Maness
authors.affiliation: Department of Surgery, East Carolina University, Greenville, North Carolina.
authors.forename: Swapnil D
authors.initials: SD
authors.lastname: Kachare
authors.affiliation: Department of Cardiovascular Sciences, East Carolina University, Greenville, North Carolina.
authors.forename: Jill N
authors.initials: JN
authors.lastname: Zink
authors.affiliation: Department of Surgery, East Carolina University, Greenville, North Carolina.
authors.forename: Carl E
authors.initials: CE
authors.lastname: Haisch
authors.affiliation: Department of Surgery, East Carolina University, Greenville, North Carolina.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Harland
authors.affiliation: Department of Surgery, East Carolina University, Greenville, North Carolina.
authors.forename: Claire
authors.initials: C
authors.lastname: Morgan
authors.affiliation: Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Guyton
authors.affiliation: Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: Avery G
authors.initials: AG
authors.lastname: Colomb
authors.affiliation: Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: David W
authors.initials: DW
authors.lastname: Barham
authors.affiliation: Brody School of Medicine, East Carolina University, Greenville, North Carolina.
authors.forename: Eric C
authors.initials: EC
authors.lastname: Katz
authors.affiliation: Department of Surgery, University of Rochester, Rochester, New York. Electronic address: michael_stoner@urmc.rochester.edu.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Stoner
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000191:economics / Q000592:standards*; D005260:Female; D006083:Graft Occlusion, Vascular / Q000191:economics / Q000401:mortality / Q000517:prevention & control*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000191:economics / Q000401:mortality / Q000628:therapy*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics; D006435:Renal Dialysis / Q000191:economics / Q000295:instrumentation* / Q000401:mortality; D012189:Retrospective Studies; D062666:Vascular Access Devices / Q000191:economics / Q000592:standards*
keywords: Arteriovenous graft; HeRO; Hemodialysis; Hemodialysis Realiable Outflow; Hemodialysis access; Vascular access