Background: Central venous stenosis and occlusion are a major cause of vascular access dysfunction and failure. The HeRO® Graft provides access for patients with central venous occlusion who are catheter-dependent or have failing fistulae or grafts by providing reliable venous outflow directly into the right atrium [Figure 1c and d]. Moreover, when combined with the use of early cannulation grafts it has the advantage of immediate access directly after the procedure. We reviewed our experience using the strategy of combining the use of HeRO graft with early cannulation graft. Method(s): Patients with suspected central venous occlusion or stenosis who are catheter-dependent or have failing fistulae or grafts were discussed in multi-disciplinary meetings. Only patients with central venous stenosis or occlusion confirmed by CT or conventional venogram were included [Figure 1a and b]. Patients with active infection, brachial artery diameter less than 3 mm, hypercoagulable state and ejection fraction less than 20 were excluded. Result(s): Five hemodialysis patients with history of multiple failed arteriovenous access and confirmed central venous occlusion were recruited. All patients underwent successful placement of HeRO graft in combination with early cannulation graft [Figure 1c and d]. All grafts were accessed within 48 hours. Median follow up was 219 days (range 32 -240 days). No adverse events were noted during the follow up period. HeRO graft thrombosis occurred in three patients, requiring re-intervention using percutaneous thrombectomy, primary patency 40%. All five grafts remain patent and functional, secondary patency 100%. Conclusion(s): HeRO® graft placement can provide vascular access in hemodialysis patients with central venous occlusion who would otherwise remain catheter dependent. Combining the use of early cannulation graft with HeRO graft placement can further reduce catheter dependence and does not appear to impact HeRO graft secondary patency.

but it requires special skills and long waiting time for fEVAR. Also management of type 1 endoleak is the most challenging leak to deal with. The emerging technology with endoanchores brought reasonable solution to deal with short neck using standard EVAR and to treat type 1 endoleak. Method(s): We will review the endoanchores registry and our experience in Saudi in using endoanchores as prophylactic to prevent and as therapeutic to treat type 1 endoleak. Result(s): The result from endoanchores registry and our experience is very promising. Conclusion(s): Endoanchores can be used as prophylactic in challenge neck anatomy to prevent trype 1 endoleak and as therapeutic to treat type 1 endoleak.

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