What is Port A implantation

"Port A" is a device implanted subcutaneously used for long term intravenous injection. The term is derived from the product name "Port-a-cath", which is one of the oldest device. however, there are several deffrent types of similar devices on the market made by different company nowadays.

The subcutaneous implantable infusion system consists of a catheter and a injection port. The port is implanted subcutanously, usually on the infraclavicular area, and can be punctured repeatly several hundred times. The catheter connected to the port was implanted into the venous system all the way to the central vein. The catheter tip was usually placed in SVC or right atrium. Thus the intravenous injection substance (such as drug for chemotherapy) will goes directly to the central vein through the catheter.

In short, it's a deviced implanted in the human body used for long-term and repeated injection of intravenous drug. Usually, it is implanted by vascular surgeon in the operation room via the right cephalic vein or internal jugular vein.

log of the day

1 Port A implantation
1 permanent dialysis catheter implantation
1 dialysis graft implantation
3 PTA of dialysis graft

the sequence of treatment for DM foot

I received a call today from our plastic surgeon. One of his inpatients was diagnosed to be a DM foot with foot ulcers. He had perated on the foot for several times to debride the necrotic tissue. According to his statement, the perfusion of those tissue were not so good. And the condition of the soft tissue got worsen after each debridement. He thus than arranged noninvasive study and image study which revealed that there is a total occlusion over the patient's femoral artery! No wonder that the lesion did not get better after debridement!
He had then call me for the possibility of revascularization.

Sure, revasclarization is a must for the tissue perfussion which is the fundamental element of wound healing. The problem is , the sequence (or priority) of treatment was obviously wrong!

From the viewpoint of a vascular surgeon, we should do as follows for a DM foot with ischemic compoment.

1. Infection control or minor debridment of the infected tissue
2. Revascularization , either PTA or bypass
3. Debridement or amputation to facilitate wound healing
4. Reconstruction, if needed

It's a pity that our physicion, let alone those patient, nearly always think about the vascular condition to late. They did not pay attention to their vascular condition. They may miss the chance of the optimal treatment.

My point is, vascular condition is the most fundamental. We have to keep in mind the diagnosis of ischemic leg.

Treatment of dialysis graft outlet stricture: covered-stent

History
A patietn of ESRD on regular dialysis vie her left upper arm graft. graft outlet segmental stricture was noted and the stenosis was refratory to repeated PTA (percutaneous balloon angioplasty).
Operative finding
During the venography study, graft outelt segmental stricture was noted. Due to the elasticity of the stricture, definite treatment is needed.
Strategy
Definite repair of the outlet stricture was needed. The options were:
1. Surgical revision, which is more invasive and time consuming. In addition, the lesion extended up to the high axillary vein make the revision more difficult. General anesthesia was needed to do the jump graft revision which will add on more anesthesia risk.
2. PTA with stent insertion. Covered-stent insertion over the stricture segment can prohibit immediate recoil and may prevent recurrent stricture in the long run. In addition, it's only a percutaneous procedure which is low risk to the patient. Thus we had proceed with covered-stent implantation to deal with the graft outlet recurrent stricture.

popliteal total occlusion: bypass with Distaflo!

History
A patient of chronic ischemic leg presented with right side gangrene toes. Image study showed right side popliteal artery total occlusion. Revascularization was thus indicated.
Op finding
The right side above knoww popliteal artery was explored to be severe calcified and severe diseased. Endarterectomy was done. The below knee popliteal artery was then explored.
Operation Strategy
PTA alone was note considered because of longer patency was expected. Due to the location of the total occlusion(just behind the knee joing), PTA with stentgrafting was not considered. A Distaflo (cuffed ePTFE graft was implanted as a bypass graft. You can see the cuff of the graft was nicely seated on the target vessel.

Conference List

Vascular Surgery is a clinical science keep on changing. A clinician has to keep up to date in order to provide the most appropriate treatment options.
Take part in academic conferences/symposium is a must for surgeons/physicians in medical center. It's our obligation to catch the state-of-the-art knowledge. By attending those related conferences/symposiums, surgeons may learn new knowledge, techniques, products to aid in their clinical practice.
I have here listed some major conferences/symposiums related to vascular surgery which other surgeons may be interested in participating in the forthcoming year .
Here is the Conferece List.

The list will be updated on regular basis and suggestions are welcome.