Like other specialized ePTFE grafts, HeRO Graft may require periodic maintenance. A percutaneous technique is recommended (e.g., a rheolytic thrombectomy system, balloon maceration, or balloon-assisted aspiration), after the ePTFE graft is completely incorporated. A surgical technique is recommended during the graft maturation period.
Use of fluoroscopy during any HeRO Graft intervention is strongly recommended.
HeRO Graft consists of two primary components:
- A Venous Outflow Component
- An ePTFE Arterial Graft Component
The Venous Outflow Component has a 5mm inner diameter (ID), 19F outer diameter (OD), and is 40cm long. It consists of radiopaque silicone with braided nitinol reinforcement (for kink and crush resistance) and a platinum-iridium radiopaque marker band at the distal tip.
The Arterial Graft Component has a 6mm ID, 7.4mm OD, and is 53cm long, inclusive of the connector. It consists of an ePTFE hemodialysis graft with PTFE beading to prevent kinking proximal to the proprietary titanium connector. The titanium connector attaches the graft component to the outflow component. The Arterial Graft Component is cannulated using standard technique according to KDOQI guidelines.
Tips for Successful Outcomes
- Percutaneous or surgical technique may be used to declot HeRO Graft. A surgical technique is recommended during the graft incorporation period to avoid risk of seroma or other complications.
- A 90cm thrombectomy tool is required to accommodate the entire length of the HeRO Graft.
- Administration of drugs such as TPA or urokinase to lyse the thrombus is recommended.
- Thrombus may be soft or gelatinous in nature and is likely to be present throughout the entire device.
Mechanical/rotational devices (e.g., Arrow-Trerotola PTD®) are contraindicated as internal damage to the Venous Outflow Component and connector may occur.
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