Summary Take home message
The HeRO graft (Hemodialysis Reliable Outflow) is suitable for dialysis patients with 1. severe central vein stenosis or occlusion 2. failed native or graft access surgery with long-term dependence on a dialysis catheter 3. exhausted vascular access (access exhausted).
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A real case: Mr. Lu’s own words
More than five years ago, Dr. Su completed Taiwan’s first SuperHeRO (the second-generation HeRO device), successfully helping a patient get free of long-term dependence on a dialysis catheter. To this day the patient still uses the HeRO graft in his arm, and dialysis runs smoothly.
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What is the HeRO Graft?
For patients on long-term hemodialysis, the dialysis access is a lifeline. However, some patients, because of long-standing access problems, develop central venous stenosis (CVS) or occlusion, so that a conventional fistula (AVF) or graft (AVG) cannot be created or cannot work properly.
The HeRO Graft is a “hybrid” vascular access device approved by the US FDA. It was designed to rescue patients with “almost no usable vessels left” who are forced to depend on a long-term tunneled cuffed catheter (TCC). It combines features of a “graft” and a “catheter”, building a highway straight to the heart that bypasses the blocked vein.
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How does the HeRO graft work?
The HeRO Graft solves the problem on the principle of a “bypass.” When the main vein carrying blood from a patient’s arm to the heart (the central vein) is narrowed or blocked, the HeRO Graft effectively re-establishes blood flow with two main components:
ePTFE graft component (arterial graft component): one end of this component connects to an artery in the arm; it is the same kind of graft ordinarily used for hemodialysis.
Venous outflow component: this is a reinforced silicone tube designed to pass directly through the blocked venous segment and deliver blood straight into the right atrium.
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reference: Merit medical website
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Who it is for:
Patients with severe central vein stenosis or occlusion
Patients for whom conventional fistula or graft surgery has failed and who need long-term dependence on a dialysis catheter
Dialysis patients with exhausted vascular access (access exhausted)
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Clinical advantages (compared with a long-term dialysis catheter):
Lower infection rate Compared with a long-term dialysis catheter, the HeRO Graft markedly lowers the risk of bacteremia.
Better dialysis adequacy It provides more stable blood flow than a catheter, improving dialysis clearance (Kt/V) and hence dialysis quality.
Quality of life A completely subcutaneous design (no tubing exposed) effectively reduces everyday inconvenience.
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The study
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This study, published in October 2025 in the Journal of Vascular Surgery, examined in depth the clinical results of HeRO graft surgery. In 232 patients who underwent surgery for central vein stenosis, the study showed:
Long-term patency: although five-year primary patency was only 4.3%, with interventional maintenance secondary patency reached 28.0%, showing its value as a last-line dialysis access.
Risk factors: the study found that using a tapered graft was significantly associated with a higher risk of loss of patency, so it should be chosen with caution in clinical practice.
Complications: common postoperative complications included hematoma (9.9%), steal syndrome (9.9%) and wound infection (7.8%).
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