Management of infected hemodialysis access grafts using cryopreserved human vein allografts.
BACKGROUND
One of the most feared complications of dialysis access is prosthetic arteriovenous (AV) graft infection, which is typically treated with AV graft removal followed by a staged dialysis graft placement elsewhere. Such a treatment approach often presents a challenge since many hemodialysis-dependent patients have limited venous access that may preclude a new AV graft or dialysis catheter placement. In this article, we review the management of AV graft infection using in situ cryopreserved human vein allografts.


METHODS
Functional and antigenic characteristics as well as the clinical experience of cryopreserved human vein allograft in dialysis access are reviewed. Surgical technique of in situ cryopreserved human allograft placement for infected prosthetic AV graft is also described.


CONCLUSIONS
Cryopreserved vein allograft is an acceptable graft conduit in difficult hemodialysis access situations. It offers surgeons the ability to deal with the infected graft in one operative procedure with low incidence reinfection and graft patency similar to conventional prosthetic graft replacement.
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston VAMC, 2002 Holcomb Blvd. (112), Houston, TX 77030, USA. plin@bcm.tmc.edu
Peter H
PH
Lin
William T
WT
Brinkman
Thomas T
TT
Terramani
Alan B
AB
Lumsden
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000379:methods; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation; D015925:Cryopreservation; D006801:Humans; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000209:etiology*; D006435:Renal Dialysis; D020858:Tissue and Organ Harvesting; D014184:Transplantation, Homologous; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation*