Surgical treatment of infected prosthetic dialysis arteriovenous grafts: total versus partial graft excision.
BACKGROUND
Thirty-five percent of hemodialysis patients with polytetrafluoroethylene grafts lose their access secondary to infection. We hypothesized that partial graft excision (PGE) for infection increases the incidence of vascular anastomotic complications when compared with total graft excision (TGE).


METHODS
The medical records of hemodialysis patients with a polytetrafluoroethylene graft infection from 1994 through 2004 were reviewed for PGE or TGE surgeries.


RESULTS
A total of 111 infected grafts were managed surgically in 90 patients: 91 grafts by PGE and 20 grafts by TGE. Complication rates were 26.4% versus 5% in the PGE and TGE groups, respectively (P = .038). The incidence of hemorrhage and graft-associated systemic sepsis was similar, whereas the incidence of local infection was increased in the PGE group (19.8% vs. 0%, P = .030).


CONCLUSIONS
Because potential access sites are limited, using PGE to salvage a site, even with a known increased incidence of local infection, represents an acceptable method for the treatment of graft infection.
Schutte
Warren P
WP
Department of Surgery, University of Kansas School of Medicine-Wichita, 929 N. Saint Francis St., Room 3082, Wichita, KS 67214, USA.
Helmer
Stephen D
SD
Salazar
Luis
L
Smith
John L
JL
D001807:Blood Vessel Prosthesis / Q000009:adverse effects / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007615:Kansas / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006435:Renal Dialysis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D019737:Transplants / Q000009:adverse effects / Q000706:statistics & numerical data*; D014656:Vascular Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data*
D011138:Polytetrafluoroethylene