Sonographic Appearance of Hemodialysis Reliable Outflow Graft (HeRO Graft)

Abstract

HeRO Graft (Hemodialysis Reliable Outflow Graft) consists of 3 components; an arterial graft component, a titanium connector and a venous outflow component. It is implanted under the skin of end-stage renal failure patients as a subcutaneous permanent access. It is a vascular graft that traverses central venous stenosis and has no venous anastomosis, thus providing blood flow from an artery direct into the central venous system. Ultrasound imaging of the 3 components of the HeRO graft is performed and described in this article. Equipment used include Phillips ultrasound machines CX-50, iU22, and EPIQ 7 with linear transducers of frequency 3 to 15 MHz and curvilinear transducers of frequency 1 to 5 MHz. HeRO graft is often the last hemodialysis access available for patients on long-term dialysis who would have typically exhausted all other hemodialysis options like the native arterio-venous fistula (AVF) and arterio-venous graft (AVG). As long-term dialysis patients run out of typical AVF/AVG accesses coupled with the increasing longevity of persons in countries where advanced medical technology is available, subcutaneously implanted grafts such as the HeRO graft may become more commonplace. Description of the sonographic appearance of the various components of the HeRO graft may help sonographers who are not familiar with the graft to image the components.