Maintaining lower limb access with the HeRO device

Central venous catheters (CVC) remain a mainstay of vascular access particularly for incident patients,
but lead to central vein stenosis (CVS) in up to 1 in 6 patents. This often leads to establishing dialysis access in the groin which in turn may result in development of CVS in the lower body, although this is poorly reported. The HeRO device was designed to address CVS by bypassing the stenosed veins with a nitinol-reinforced silicone tube into the right atrium, which acts as an outflow conduit attached to an arterial inflow. The efficacy and safety of the HeRO device in the upper limb is well established, but there is no data on its use in the lower limb. We describe 2 cases of HeRO in the lower limb, one primary and one secondary, which remain in use. Lower limb HeRO is feasible in the lower limb and can work well either as de novo (to achieve vascular access) or as a salvage procedure (to maintain vascular access).