A 71-year-old woman with no relevant previous medical history presented to the emergency department with cardiopulmonary arrest due to extensive myocardial infarction. Veno-arterial extracorporeal life support (ECLS) was passed through the right common femoral artery (CFA), and an Impella CP® (16-F introduction sheath, Abiomed Inc., Danvers, MA, USA) was inserted from the left CFA. Although these mechanical devices provide powerful cardiac and organ support, an occlusive large-bore sheath may induce ischemic limb complications. Antegrade flow from the contralateral sheath was circulated through the ECLS circuit, showing the improvement of antegrade left SFA. Cardiac function improved after primary percutaneous coronary intervention, but when the ECLS was terminated, antegrade left limb flow declined. Hence, we bypassed the contralateral flow via the dialysis circuit and prevented limb ischemia.
UNASSIGNED: Although an Impella® (Abiomed Inc., Danvers, MA, USA) is useful for assisting left ventricular cardiac function, its large-bore sheath sometimes disturbs the antegrade flow, resulting in ischemic limb complications. A novel yet simple technique that involves an external bypass through the superficial femoral artery to provide antegrade perfusion to the ipsilateral limb is hereby described.

End-stage renal disease is a prevalent medical condition causing significant problems as the majority of patients are being treated with dialysis. While dialysis provides a means to compensate for the renal impairment, arteriovenous grafts and fistulas are often complicated by neointimal hyperplasia, loss of primary patency, and graft failure. Over the last decade, stent grafts have emerged as an alternative to balloon angioplasty and bare metal stents for revascularization in the event of arteriovenous graft occlusion or stenosis. Several randomized controlled trials have investigated the efficacy of stent grafts compared with balloon angioplasty for improving the function and durability of dialysis circuits. In this review, we present a comprehensive review of clinical trials. Stent grafts appear to offer increased primary patency over balloon angioplasty in the treatment of dialysis circuit stenosis. However, there is generally no significant difference between the two treatment modalities on other clinically relevant measures like complication rates and overall survival.