{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T07:06:55Z","timestamp":1784531215162,"version":"3.55.0"},"reference-count":20,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T00:00:00Z","timestamp":1770336000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Vasc Access"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Hemodialysis Reliable Outflow (HeRO) graft is vital for complex hemodialysis patients who have exhausted all other access options. Hemodialysis access-induced distal ischemia (HAIDI) is a serious complication, however, risk factors for HAIDI after HeRO graft operation are unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Institutional records were retrospectively reviewed for all index HeRO graft implantations performed between 2014 and 2023. Re-do HeRO grafts were excluded. Patient demographics, operative details, and postoperative outcomes were collected. Primary outcome was symptomatic HAIDI following HeRO surgery. Statistical analysis was performed using univariate tests, logistic regression analysis, and Kaplan-Meier estimates for patency.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Over the 10-year study period, 232 index HeRO surgeries were performed of which 23 (9.9%) developed symptomatic HAIDI. Patients with HAIDI were older than their counterparts (64.0\u2009\u00b1\u200913.7 vs 57.0\u2009\u00b1\u200913.3 y,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.008). All other demographic factors and comorbidities were similar between groups (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009NS each). For inflow, patients with HAIDI more frequently underwent brachial artery anastomosis (78.3% vs 65.1%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.04), and less frequently utilized a prior arteriovenous graft or fistula (8.7% vs 25.8%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.04). The use of a tapered graft was similar between groups (47.8% vs 31.1%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.10). On multivariable analysis, only patient age (hazard ratio (HR) 1.06\u2009per year, 95% confidence interval [CI], 1.02\u20131.10,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.003) was independently associated with symptomatic HAIDI. Tapered graft utilization was not associated with reduced risk of HAIDI (HR 0.75, 95% CI, 0.23\u20132.38,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.61). Patients with HAIDI had significantly higher 30-day hospital readmission rates (34.8% vs 17.7%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.0049) and reduced secondary graft patency rates (1-year, 46.0\u2009\u00b1\u200911.4% vs 71.3\u2009\u00b1\u20093.6%; 3-year, 23.7\u2009\u00b1\u200911.1% vs 44.0\u2009\u00b1\u20094.8%,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Symptomatic HAIDI is fairly common after HeRO graft implantation and portends inferior long-term outcomes with older age being the only associated risk factor. Tapered conduits were not associated with reduced risk of HAIDI. These data are valuable for informed consent and shared decision-making among patients undergoing HeRO graft surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11297298261415963","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T10:54:43Z","timestamp":1770375283000},"page":"1657-1662","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence and risk factors for hemodialysis access-induced distal ischemia after hemodialysis reliable outflow (HeRO) surgery"],"prefix":"10.1177","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2534-4515","authenticated-orcid":false,"given":"Anthony N","family":"Eze","sequence":"first","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina L","family":"Cui","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tristen T","family":"Chun","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin W","family":"Southerland","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Young","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"e_1_3_2_2_2","first-page":"146","article-title":"Dialysis-associated steal syndromes","volume":"63","author":"Sen I","year":"2022","unstructured":"Sen I, Tripathi R. Dialysis-associated steal syndromes. J Cardiovasc Surg (Torino) 2022; 63: 146\u2013154.","journal-title":"J Cardiovasc Surg (Torino)"},{"issue":"2","key":"e_1_3_2_3_2","first-page":"325","article-title":"Embolic and ischemic complications after anastomosis of radial artery to cephalic vein","volume":"66","author":"Storey BG","year":"1969","unstructured":"Storey BG, George CR, Stewart JH, et al. Embolic and ischemic complications after anastomosis of radial artery to cephalic vein. 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