Abstract：
UNASSIGNED: A 48-year-old patient presented 4 months after insertion of a right sided Haemodialysis with Reliable Outflow (HeRO®, Merit Medical) graft with a discharging abscess at the site of the brachial artery anastomosis. There was localised involvement of the arterial Gore® Acuseal inflow graft that necessitated its removal. The venous outflow component was thought salvageable as infection was well localised to the region of the antecubital fossa.
UNASSIGNED: Alternative access options were limited so we sought to preserve the venous outflow portion of the patient\'s original graft - minimising tissue damage and avoiding the need for a dialysis line.
UNASSIGNED: The infected arterial graft was excised, leaving behind the original SuperHero® connector and venous graft. A left sided tunnelled axillary necklace technique was utilised to restore arterial inflow.
UNASSIGNED: After a four-day recovery, the patient went on to successfully resume their usual haemodialysis regimen without any complications. Convalescent imaging, repeat blood cultures, and monitoring of inflammatory markers showed no signs of residual infection at 6 weeks.
UNASSIGNED: The originality of this case was the way in which an axillary necklace inflow graft was connected to the pre-existing venous outflow portion of the HeRO® haemodialysis graft system, allowing the excision of the infected inflow graft at the brachial anastomosis. This technique could be viewed as an effective salvage procedure as it allowed the venous outflow portion of the original graft to remain in situ, minimised tissue damage and enabled the patient to swiftly resume haemodialysis without the need for a line.
UNASSIGNED: Alternative access options were limited so we sought to preserve the venous outflow portion of the patient\'s original graft - minimising tissue damage and avoiding the need for a dialysis line.
UNASSIGNED: The infected arterial graft was excised, leaving behind the original SuperHero® connector and venous graft. A left sided tunnelled axillary necklace technique was utilised to restore arterial inflow.
UNASSIGNED: After a four-day recovery, the patient went on to successfully resume their usual haemodialysis regimen without any complications. Convalescent imaging, repeat blood cultures, and monitoring of inflammatory markers showed no signs of residual infection at 6 weeks.
UNASSIGNED: The originality of this case was the way in which an axillary necklace inflow graft was connected to the pre-existing venous outflow portion of the HeRO® haemodialysis graft system, allowing the excision of the infected inflow graft at the brachial anastomosis. This technique could be viewed as an effective salvage procedure as it allowed the venous outflow portion of the original graft to remain in situ, minimised tissue damage and enabled the patient to swiftly resume haemodialysis without the need for a line.
摘要：
■一名48岁的患者在插入右侧血液透析4个月后出现了可靠的流出（HeRO®，MeritMedical）移植物，在肱动脉吻合部位有脓肿。动脉Gore®Acuseal流入移植物局部受累，需要将其移除。静脉流出成分被认为是可以挽救的，因为感染很好地定位在肘前窝区域。
■可供选择的途径有限，因此我们寻求保留患者原始移植物的静脉流出部分-最大限度地减少组织损伤并避免需要透析管路。
■切除感染的动脉移植物，留下原始的SuperHero®连接器和静脉移植物。使用左侧隧道腋窝项链技术恢复动脉流入。
■经过四天的恢复，患者继续成功恢复常规的血液透析方案，没有任何并发症。康复期成像,重复血液培养,和监测炎症标志物显示在6周时没有残留感染的迹象。
■这种情况的独创性是将腋窝项链流入移植物连接到HeRO®血液透析移植物系统的预先存在的静脉流出部分的方式，允许在臂吻合处切除感染的流入移植物。这种技术可以被视为一种有效的抢救程序，因为它允许原始移植物的静脉流出部分保持在原位。最大限度地减少组织损伤，使患者能够迅速恢复血液透析，而不需要一条线。
■可供选择的途径有限，因此我们寻求保留患者原始移植物的静脉流出部分-最大限度地减少组织损伤并避免需要透析管路。
■切除感染的动脉移植物，留下原始的SuperHero®连接器和静脉移植物。使用左侧隧道腋窝项链技术恢复动脉流入。
■经过四天的恢复，患者继续成功恢复常规的血液透析方案，没有任何并发症。康复期成像,重复血液培养,和监测炎症标志物显示在6周时没有残留感染的迹象。
■这种情况的独创性是将腋窝项链流入移植物连接到HeRO®血液透析移植物系统的预先存在的静脉流出部分的方式，允许在臂吻合处切除感染的流入移植物。这种技术可以被视为一种有效的抢救程序，因为它允许原始移植物的静脉流出部分保持在原位。最大限度地减少组织损伤，使患者能够迅速恢复血液透析，而不需要一条线。
