Volume 48, Issue 3 September 2024 JVU 483-179 | Sonographic Appearance of a Hemodialysis Reliable Outflow Graft (HeRO Graft)-Volume 48, Issue 3 September 2024 JVU 483-179 | Sonographic Appearance of a Hemodialysis Reliable Outflow Graft (HeRO Graft)

Volume 48, Issue 3 September 2024 JVU 483-179 | Sonographic Appearance of a Hemodialysis Reliable Outflow Graft (HeRO Graft)

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The article "Sonographic Appearance of Hemodialysis Reliable Outflow Graft (HeRO Graft)" authored by Chancy Lim from the National University Heart Centre, Singapore, revolves around the sonographic imaging and analysis of HeRO Graft components used in end-stage renal failure patients. The HeRO Graft, a subcutaneously implanted vascular graft, facilitates the passage of blood from an artery directly into the central venous system, bypassing central venous stenosis without requiring a venous anastomosis.<br /><br />The study utilized various Philips ultrasound systems (CX-50, iU22, and EPIQ 7) and transducers with frequencies ranging from 1 to 15 MHz to image and evaluate the HeRO Graft components: the arterial graft component, the titanium connector, and the venous outflow component.<br /><br />Key findings are discussed as follows:<br /><br />1. <strong>Arterial Graft Component</strong>: Comprising expanded polytetrafluoroethylene (ePTFE), this component connects to the native brachial artery and appears as typical hyperechoic parallel lines on ultrasound. It may develop complications such as pseudoaneurysms, stenosis, or thrombosis.<br /><br />2. <strong>Titanium Connector</strong>: Serves as the transition link between the arterial graft component and the venous outflow component. Due to its metal content, it causes significant acoustic shadowing, which leads to a hypoechoic or anechoic appearance of tissues posterior to the connector in ultrasound imaging.<br /><br />3. <strong>Venous Outflow Component</strong>: Tunnels under the skin through central venous stenosis, terminating in the right atrium. It is designed to provide flexibility and resistance against kinking and crushing. Its mesh-like sonographic appearance is attributed to the nitinol reinforcement.<br /><br />The article underscores the HeRO Graft as the last resort for long-term dialysis patients who have exhausted traditional arterio-venous fistulas (AVFs) and arterio-venous grafts (AVGs). Given the increasing life expectancy globally, familiarity with HeRO Graft sonography is essential for medical professionals to ensure high-quality dialysis access imaging.<br /><br />The study also stresses the importance of comprehensive knowledge of the HeRO Graft’s sonographic signatures to effectively manage dialysis access complications and highlights the potential rise in utilization as life expectancy increases.

Keywords

HeRO Graft

sonographic imaging

end-stage renal failure

vascular graft

Philips ultrasound systems

arterial graft component

titanium connector

venous outflow component

dialysis access

complications