Infected dialysis graft- local excision with bypass

This is how we deal with a recurrent dialysis ePTFE infection. The infection is localized at the bending area of the forearm loop graft. The graft was patent with good flow. However, there was repeated graft infection despite of debridement procedures.

Usually we have to deal with this kind of situation aggressively. That is to say, we have to remove all the infected segment of ePTFE graft. In this case, the infected segment (which was located just at the bending portion of the loop) had to be removed. According to the principle of surgery, we did the bypass surgery prior to the removal of infected portion to maintain the flow. We did bypass from the arterial limb to the venous limb, and we have tunneled the new graft through the healthy area to avoid contamination. After the flow of dialysis access was established, we then extracted the infected segment through the previously infected open wound (where the exposed graft lied). The dirty wound had been put on wet dressing.

And the patient can be put on dialysis via the original access without problem since the puncture area was non-touched.

less invasive revascularization

This is a case I have completed today.
A 80 y.o. gentleman ,who suffered from intermittent claudication for a long time. A total occlusion over his left thigh artery was diagnosed. From the angiography above, you can see there is a block on the artery which makes the distal artery lack of blood flow. Since the smptoms getting worse day by day, he was suggested to have a "revascularization".
In the old days, we surgeons tend to do "open bypass" which means insertion of a artifical tube into the leg to drain the blood from healthy arteries to distal artery. Usually the bypass surgery needs to cut multiple wounds on the leg and to make tunnels in the leg to insert the artifical artery. Sure the procedure is a painfula and lengthy procedure with relatively painful recovery course.
Nowadays we adopt the so call "endovascular revascularization". Like in this case, we have just stick a tiny hole on the thigh (without even using a blade!) and insert some king of balloon catheter into the artery. We have found the blockage under X ray and open the blockage by balloon. No cutting or sutures on the artery needed. No painful tunneling in the flesh needed. The recovery course will be very easy to the patient and he will be able to walk a couple of hours later.

Thanks to the endovascualr technique, we can render more effective treatments to patients with artery diseases in a less invasive fashion.