By Leslie Shepherd

Dr. Greco holds a T-shirt with an image of the HeRO Graft she implanted
Vascular surgeon Dr. Ellisa Greco holds a T-shirt with an image of the HeRO Graft she implanted.

Dr. Elisa Greco is the first surgeon in Canada to use a recently approved device to provide permanent hemodialysis access for patients with end-stage kidney disease whose existing access is blocked or damaged.

It’s called the Hemodialysis Reliable Outflow graft device or HeRO Graft and it’s designed for patients who have exhausted all other access options.

Before starting hemodialysis, most patients undergo a procedure in which a surgeon connects an artery and a vein in the arm, creating a “fistula” to allow as much blood as possible to flow out of the body to be filtered by the hemodialysis machine.

But many patients are not candidates for a fistula because their veins are too small or they have stenosis, or narrowing, in spots. Some may have a graft implanted, artificially connecting the artery and the vein.

But if all those options fail, there is the HeRO Graft, and Dr. Greco, a vascular surgeon, has implanted many of them. The company newly redesigned the product, which was recently approved in Canada and she has implanted this in two patients so far. With longer term outcomes in patients with HeRO grafts the company had noted common complications associated with the initial graft design. Dr. Greco made all the arrangements for the first one during her last week on maternity leave and did the procedure her first week back.

The graft is made up of two parts, both of which are completely implanted under the skin. Using a type of imaging called fluoroscopy, which shows a continuous X-ray image on a monitor, Dr. Greco first made a small incision in the neck and fed a catheter through a large vein into the right atrium of the heart. The catheter is then threaded or tunneled under the skin to the front of the shoulder.

The second step is to insert a dialysis graft through the arm, where the dialysis needle will later be inserted. One end is sewn to an artery and the other is connected to the catheter. Blood starts flowing between the two as soon as they are connected.

The Ontario Renal Network recognizes St. Michael’s as a Centre of Practice for dialysis access.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Center, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.