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Published byDale Bryan Modified over 9 years ago
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Fewer HeRO Grafts and More Transposed Femoral Vein Fistulas Our Changing Approach to Management Of Bilateral Central Venous Stenosis Eric Ladenheim MD Ladenheim Dialysis Access Centers
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12 OF 33 HERO IN STRAIGHT CONFIG
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21 OF 33 HERO IN LOOP CONFIG
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HERO GRAFT PRIMARY AND SECONDARY PATENCIES 25% 1 year primary patency rate 90% 1 year secondary patency rate
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9 SUPERFICIAL FEMORAL ARTERY- TRANSPOSED FEMORAL VEIN THIGH FISTULAS
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61 y/o woman with HeRO complicated by excessive ultrafiltration. Hx Bladder CA Occult lliac vein occlusion in our first SFA-tFV fistula Difficulties with our first SFA-tFV thigh fistula
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All 9 Patients had palpable pulses preoperatively Duplex assessment of Superficial femoral vein size and patency Contrast venography (8/9) to verify adequate venous runoff Our Workup for SFA-tFV Fistula
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Complications
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CANNULATIONS IN THIGH FISTULA PATIENTS 6 12
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DAYS TO CANNULATION
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NO SIGNIFICANT DIFFERENCE BETWEEN GROUPS
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FOLLOW UP INFORMATION
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CUMULATIVE PRIMARY PATENCY
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FEWER HERO GRAFTS & MORE THIGH FISTULAS
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Conclusions Our Practice has made a significant shift from HeRO grafts to SFA-tFV thigh fistulas as our first choice for patients with bilateral central venous stenosis. There has been a significant learning curve for the SFA-tFV thigh fistula Longer follow up needed for proper comparison between the techniques
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