Infection of hemodialysis arteriovenous grafts.
OBJECTIVE
Prosthetic arteriovenous grafts (AVG) are bedeviled by significant infectious complications. This study was to determine the infectious complications of prosthetic AVG and review the relevant literature.


METHODS
All prosthetic AVG inserted between January 2000 to December 2007 were studied. Data on age, sex, date of graft insertion, indication for AVG, site of graft insertion, date of graft related infection, treatment and outcome for graft and patients were analyzed.


RESULTS
There were 84 AVG inserted into 58 patients. Thigh AVG accounted for 55% of cases whereas upper arm AVG was inserted in 39%. Thirteen (17.3%) AVG were associated with one or more episodes of infection. The infection rate for SynerGraft (50%) was statistically significantly different from that of PTFE (12%) - Yates' x2=6.164; df=1; p=0.013. The rate of infection was higher for thigh grafts (9/37) compared to other sites (4/34), but the difference was not statistically significant (Yates' x2=1.123; df=1; p=0.289). Only one death was directly related to AVG infection in this series.


CONCLUSIONS
Infectious complications of AVG require prompt surgical or radiological intervention to save life or access. The need to excise an infected graft completely is sometimes counterbalanced by the compelling need to provide vascular access for hemodialysis in a patient with limited access options.
Akoh
Jacob A
JA
Surgery and Renal Services Directorate, Plymouth Hospitals NHS Trust, Plymouth, UK. Jacob.akoh@phnt.swest.nhs.uk
Patel
Neil
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D016009:Chi-Square Distribution; D020878:Device Removal; D004739:England; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D034941:Upper Extremity / Q000098:blood supply*
D000900:Anti-Bacterial Agents; D011138:Polytetrafluoroethylene