Management of tunnel infections of dialysis polytetrafluoroethylene grafts.
Extensive tunnel infections of polytetrafluoroethylene (PTFE) dialysis grafts have traditionally been managed by total excision, including venous and arterial anastomoses. This article describes an alternative vascular approach to excision of infected dialysis PTFE grafts; success occurred in 14 of 15 excised grafts in 12 patients. The surgical procedure consisted of a 2 to 3 mm oversewn cuff of PTFE left at the arterial anastomosis, with excision of the remaining graft including the venous anastomosis. The entire tunnel tract was opened, debrided, and irrigated extensively with cefazolin solution. Wounds were closed over drains. Fourteen PTFE graft excisions healed without sequelae. This small but successful series of excised, infected PTFE dialysis grafts supports the procedure to leave a small cuff of oversewn PTFE on the artery and to close the wounds primarily over drains.
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000295:instrumentation; D001424:Bacterial Infections / Q000628:therapy*; D006801:Humans; D011138:Polytetrafluoroethylene; D019736:Prostheses and Implants / Q000009:adverse effects*; D012086:Reoperation; D013536:Suture Techniques
D011138:Polytetrafluoroethylene