title: A Review on the Hemodialysis Reliable Outflow (HeRO) Graft for Haemodialysis Vascular Access.
abstract: OBJECTIVE
  With improved dialysis survival there are increasing numbers of patients who have exhausted definitive access options due to central venous stenosis and are maintaining dialysis on a central venous catheter. The Hemodialysis Reliable Outflow (HeRO) allows an alternative by providing a definitive access solution. The aim of this study is to systematically review the published outcomes of the HeRO graft and discuss the role in complex haemodialysis patients.
  
  
  METHODS
  Electronic databases were searched for studies assessing the use of the HeRO graft for dialysis in accordance with PRISMA published up to December 31 2014. The primary outcomes for this study were 1-year primary and secondary patency rates. Secondary outcomes were rates of dialysis access associated steal syndrome, HeRO-related bacteraemia rates and rates of interventions.
  
  
  RESULTS
  Following strict inclusion/exclusion criteria, eight studies including 409 patients were included in our review. Primary and secondary pooled patency rates in this complex cohort of dialysis patients were found to be 21.9% (9.6-37.2%) and 59.4% (39.4-78%). The rate of dialysis access associated steal syndrome was low at 6.3% (1-14.7%) as was the range of HeRO-related bacteraemia (0.13-0.7 events per 1000 days).
  
  
  CONCLUSIONS
  This literature review shows that the HeRO graft is an acceptable option for complex dialysis patients who are catheter dependent. Owing to device availability, published data are predominantly North American and further longer-term studies in other populations may be necessary. In this challenging patient group, randomized controlled trials are required to allow comparisons with alternative access options.
authors.affiliation: Department of Renal Surgery, QEHB, University Hospital Birmingham, Birmingham, UK; ReDVA Research Consortium, University of Dundee, Dundee, UK. Electronic address: j.alshakarchi@nhs.net.
authors.forename: J
authors.initials: J
authors.lastname: Al Shakarchi
authors.affiliation: ReDVA Research Consortium, University of Dundee, Dundee, UK; Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, UK.
authors.forename: J G
authors.initials: JG
authors.lastname: Houston
authors.affiliation: Department of Radiology, QEHB, University Hospital Birmingham, Birmingham, UK.
authors.forename: R G
authors.initials: RG
authors.lastname: Jones
authors.affiliation: Department of Renal Surgery, QEHB, University Hospital Birmingham, Birmingham, UK; ReDVA Research Consortium, University of Dundee, Dundee, UK.
authors.forename: N
authors.initials: N
authors.lastname: Inston
mesh_terms: D006801:Humans; D006435:Renal Dialysis / Q000295:instrumentation*; D062666:Vascular Access Devices
keywords: Catheter; Graft; Haemodialysis; HeRO; Outflow