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.