Elizabeth’s life-saving HeRO

Posted on in Services, The trust

Elizabeth Fraser was given the ‘best Christmas present’, a life-saving procedure at The James Cook University Hospital in Middlesbrough and now looks forward to a brighter 2016.

The HeRO (Haemodialysis Reliable Outflow) graft operation– the first one of its kind in the North East – was carried out on the 55 year-old dialysis patient as the last possible course of action the medical team looking after her could offer her.

Richard Laughton, right, from CryoLife – makers of the HeRO graft - illustrates how it works to Dr Ahmed Kaabneh, consultant radiologist and Miss Monica Hansrani, consultant vascular surgeon

Richard Laughton, right, from CryoLife – makers of the HeRO graft – illustrates how it works to Dr Ahmed Kaabneh, consultant radiologist and Miss Monica Hansrani, consultant vascular surgeon

Due to the state and continuing deterioration of Elizabeth’s veins after 15 years of dialysis and previous operations, this procedure involved putting a length of silicone-coated catheter inside her central vein in her neck to re-enforce the collapsing vein. The catheter’s diameter is three times wider than a conventional stent and goes from one of her heart vessels to beneath her collar bone and shoulder blade.

A titanium connector then runs a second graft from there under the skin to the main vein in the inside of her elbow. It will be this area that will be used in further dialysis treatment.

Without this procedure dialysis would no longer be possible for Elizabeth and the outcome would be a lot bleaker.

Elizabeth, a social care manager from Catterick Garrison, said before the operation: “I no longer have good veins and for access for my dialysis and I need a good vein. Over the years the clinicians have exhausted all the conventional options and this new procedure is ideally made for patients like me. It’s come in the nick of time for me as I’m running out of options. It is the best Christmas present I could have asked for.

“It’s called a hero graft and it does exactly what it says on the tin! It’s quite heroic to keep people like me going with access to dialysis. I’m prone to blood clots and once the vein is clotted it is no longer usable for dialysis treatment.

“This HeRO graft has been used over in the States for about ten years I believe and the success rate is very encouraging. I think I’m very fortunate that this has come along at this time. I have every faith in the team. They are wonderful. I’ve met them so many times over the years.”

There have been over 50 such procedures in the UK to date, but this is the first one to be carried out in North East England.

Miss Monica Hansrani, consultant vascular surgeon, who helped to carry out the three-hour procedure with other vascular and radiology consultants, said: “This procedure is a last-line option. It is to benefit those on dialysis whose last access point, usually in the neck, begins to deteriorate and fail.

HeRO graft 1

From left to right: Miss Monica Hansrani, consultant vascular surgeon; Dr Ahmed Kaabneh, consultant radiologist; Dr Didem Tez, renal consultant; Mr Barnabas Green, consultant vascular surgeon; Sandhya Mathew, Access co-ordinator and Richard Laughton, from CryoLife – makers of the HeRO graft.

“This catheter is more durable, withstanding a lot more pressure from outside and, because it’s much bigger than conventional stents, it will allow more rapid access dialysis and hopefully stay open for much, much longer. There are cases where they have been in for four and a half years.”

Miss Hansrani added: “The procedure involves close teamwork. A consultant radiologist inserts the main catheter to the heart using x-ray guidance and then the vascular surgeon works the second graft under the skin to join onto the main catheter. This second graft is the one which will allow access to dialysis.”

A bonus of the HeRO system is that the company has designed the device in such a way as to allow the team to tailor the components to the specific access needs of the patient – offering a truly individualised access solution. In this case Elizabeth needed to dialyse within a few hours. Conventional grafts require a ‘settling in’ period of around two weeks before patients can resume dialysis safely, time Elizabeth didn’t have. By combining the HeRO system with an ‘instant-stick graft’ (a new self-sealing graft from Gore, called Acuseal) the surgeons guaranteed Elizabeth was able to dialyse almost immediately after the procedure was complete.