Overcoming Central Venous Occlusion: The First HeRO Graft Procedure in the Baltic States
- 1Clinic of Gastroenterology, Nephro-Urology and Surgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, 03101 Vilnius, Lithuania
- 2Center for Vascular Reconstructive and Endovascular Surgery, Vilnius University Hospital Santaros Klinikos, 08406 Vilnius, Lithuania
- 3Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania
Abstract
Background: Central venous occlusive disease is a major challenge in hemodialysis patients who have exhausted conventional vascular access options and may lead to long-term dependence on tunneled central venous catheters. The Hemodialysis Reliable Outflow (HeRO) graft provides an alternative by bypassing obstructed central veins and enabling catheter-free upper-extremity vascular access. Case presentation: We report the first HeRO graft implantation in Lithuania in a 78-year-old woman with end-stage kidney disease and extensive central venous occlusive disease. Previous arteriovenous fistulas had failed because of thrombosis and severe venous hypertension, while prolonged catheter dependence was complicated by recurrent infections, dislodgements, and multiple catheter exchanges. The HeRO venous outflow component was implanted through the existing tunneled catheter access and positioned in the right atrium. It was connected to an early-cannulation expanded polytetrafluoroethylene graft anastomosed to the brachial artery. Completion fistulography demonstrated unobstructed flow through the system into the right atrium. The procedure was technically successful, and the graft was successfully cannulated for hemodialysis 24 h after implantation, avoiding the need for temporary catheter placement. Conclusions: The HeRO graft may provide a valuable catheter-sparing option for carefully selected hemodialysis patients with severe central venous occlusive disease and no feasible conventional upper-extremity access. This case demonstrates its technical feasibility in a complex vascular access setting and highlights the potential role of an early-cannulation graft when immediate catheter removal is necessary.
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BibTeX
@article{vitkauskaitė2026overcoming,
title = {{Overcoming Central Venous Occlusion: The First HeRO Graft Procedure in the Baltic States}},
author = {Monika Vitkauskaitė and Dalia Bogomolovienė and Andrius Drobnys and Simonas Jonas Norvydas and Laurynas Rimševičius and Diana Sukackienė and Marius Miglinas},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218347},
url = {https://www.mdpi.com/2077-0383/15/21/8347},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Overcoming Central Venous Occlusion: The First HeRO Graft Procedure in the Baltic States
AU - Monika Vitkauskaitė
AU - Dalia Bogomolovienė
AU - Andrius Drobnys
AU - Simonas Jonas Norvydas
AU - Laurynas Rimševičius
AU - Diana Sukackienė
AU - Marius Miglinas
PY - 2026
DA - 2026/10/27
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218347
UR - https://www.mdpi.com/2077-0383/15/21/8347
AB - Background: Central venous occlusive disease is a major challenge in hemodialysis patients who have exhausted conventional vascular access options and may lead to long-term dependence on tunneled central venous catheters. The Hemodialysis Reliable Outflow (HeRO) graft provides an alternative by bypassing obstructed central veins and enabling catheter-free upper-extremity vascular access. Case presentation: We report the first HeRO graft implantation in Lithuania in a 78-year-old woman with end-stage kidney disease and extensive central venous occlusive disease. Previous arteriovenous fistulas had failed because of thrombosis and severe venous hypertension, while prolonged catheter dependence was complicated by recurrent infections, dislodgements, and multiple catheter exchanges. The HeRO venous outflow component was implanted through the existing tunneled catheter access and positioned in the right atrium. It was connected to an early-cannulation expanded polytetrafluoroethylene graft anastomosed to the brachial artery. Completion fistulography demonstrated unobstructed flow through the system into the right atrium. The procedure was technically successful, and the graft was successfully cannulated for hemodialysis 24 h after implantation, avoiding the need for temporary catheter placement. Conclusions: The HeRO graft may provide a valuable catheter-sparing option for carefully selected hemodialysis patients with severe central venous occlusive disease and no feasible conventional upper-extremity access. This case demonstrates its technical feasibility in a complex vascular access setting and highlights the potential role of an early-cannulation graft when immediate catheter removal is necessary.
SN - 2077-0383
ER -