Hemodialysis Reliable Outflow device impingement in the subclavian position: a case report

The Journal of Vascular Access
John YerxaJ H Lawson

Abstract

The purpose of this study is to report a case of Hemodialysis Reliable Outflow (HeRO) device malfunction in the subclavian position secondary to costoclavicular impingement. The electronic medical record was reviewed for the patient in question and pertinent imaging was collected and photographs were taken with the patient's consent. The patient presented with signs of outflow obstruction after a period of HeRO venous outflow component function. The outflow component was found to be crushed between the first rib and the clavicle at the costoclavicular junction. This case suggests that costoclavicular impingement should be considered as a mode of outflow failure with the HeRO outflow component in the subclavian position. Other central venous access points should be considered first, and the central veins accessed through the lower extremities are possible alternatives if this failure mode was to arise. First rib resection would also be a viable strategy to relieve impingement at this site.

References

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Mar 5, 2005·ASAIO Journal : a Peer-reviewed Journal of the American Society for Artificial Internal Organs·Jennifer M MacRaeMercedeh Kiaii
Dec 22, 2010·Annals of Vascular Surgery·Javier E Anaya-AyalaEric K Peden

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Citations

Apr 20, 2021·The Journal of Vascular Access·Karl A IlligJohn R Ross

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