Arteriovenous Graft Infection: Clinical Features and Management (original) (raw)
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Infection of Hemodialysis Arteriovenous Grafts
The Journal of Vascular Access, 2010
Purpose 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; ...
Infectious complications of arteriovenous eptfe grafts for hemodialysis
Biomedical Papers, 2010
Background. Insufficient venous vasculature disallows autologous arteriovenous fistula creation. In this case an arteriovenous conduit of expanded polytetrafluoroethylene (ePTFE) interponed between artery and vein is used for hemodialysis. Although arteriovenous graft infection is an infrequent complication, infected grafts cannot be used for hemodialysis and can cause infection, sepsis and bleeding. Treatment options remain limited but the general approach is to maintain functional angioaccess and to eradicate infection. Aim. to summarize current knowledge of the prevention and treatment of arteriovenous graft infection. Methods. literature review Conclusions. ePTFE graft present an unreplaceable material used for angioaccess in patients with an insufficient venous vasculature. A number of risk factors causing graft infection is known. Since hemodialysis patients are a highrisk group, an effective strategies for graft infection prevention and early diagnosis should be determined. Among the most important risk factors belong surgical procedure, recurrent venipuncture and other infection disease. The prostheses should be removed when infected, especially in the presence of sepsis. In case of "localized infection", the prostheses can be removed partially only under the condition of careful patient selection and subsequent follow-up.
ARTERIOVENOUS GRAFT INFECTION IN HAEMODIALYSIS PATIENTS: A CLINICAL AND MICROBIOLOGICAL ANALYSIS
Aim: The aim of this study was to analyse the clinical outcomes and describe the microbiological profiles of arteriovenous graft infections in Jordanian Royal medical services. Methods: We performed a retrospective study of arteriovenous graft (AVG) procedures that were performed at our institution between January 2015 and December 2018. Data on the patient's demography, site of graft insertion, and date of graft-related infection were collected from our registry. Cultures and sensitivity to antibiotics were determined for all bacterial strains using VITEK2. The treatment and outcome for patients with a graft infection were analysed. Result: Of the 520 AVGs inserted during the four-year study period, 86 (16.5%) AVG infections were identified in 72 patients. The mean age of the patients was 42 years (range 18-82 years) and 56 (65%) of the patients were male. An infected AVG was identified by clinical, ultrasound, and microbiological findings. Strains of Staphylococcus spp., especially S. aureus, were the most frequent cause of infected AVG, which accounted for 52 (60.5%) of the infected grafts. The second most frequent infectious species was S. epidermidis, which was detected in 15 (17.5%) cultures. The rate of AVG infection was statistically significant for patients with diabetes mellitus p=0.003), thigh grafts (p=0.04), anaemia (p=0.01), and high White blood cells on admission (p=0.01) in infected grafts group compared with patients without grafts infection as a control group. The overall patient mortality was 19 (22%) patients; the cause of death was graft-related in 4 (4.7%) patients in this series. Conclusion Strains of Staphylococcus, especially S. aureus, were the most frequent cause of infected AVGs. management of patients with graft infection could be individualized by total graftectomy or partial graftectomy according to patient's condition. Because haemodialysis patients are a high-risk group precaution measures should be taken to decrease the risk of infection.
Journal of Vascular Surgery, 2010
Introduction: Prosthetic arteriovenous grafts (AVGs) in the lower extremity represent a useful alternative for hemodialysis vascular access when all upper limb access sites have been used or in some patients when freedom of both hands is necessary during dialysis. Reported complications include an increased risk of infection and limb ischemia. This study evaluated our experience with the patency outcomes and complication rates of polytetrafluoroethylene (PTFE) AVGs placed in the thigh. Methods: A retrospective outcomes analysis was performed of all femoral AVGs inserted between January 1992 and July 2007. Data were obtained by review of medical records for patient demographics, comorbidities, and AVG-related outcomes. Patency, complication rates, and risk factors for infection were determined. Results: A total of 153 prosthetic AVGs were placed in 127 patients (63 men). Mean patient age was 52.7 ؎ 16.3 years. Median follow-up was 25 months (range, 1-169 months). The most common underlying renal disease was glomerulonephritis in 27 (21%). Hypertension and coronary artery disease were common comorbidities, respectively, in 49 (39%) and 23 patients (18%). The primary and secondary AVG patency rates at 12 months were 53.9% and 75.3%, respectively, and 2-and 5-year patency rates were, respectively, 39.6% and 19.3% (primary) and 63.8% and 50.6% (secondary). The mean AVG survival for all cases was 31.6 months (range, 0-149 months). Surgical thrombectomy was required in 82 (54%), and 22 AVGs (14%) required surgical revision for stenosis. Infection occurred in 41 AVGs (27%), and limb ischemia occurred in 2 (1.3%). Statistical analysis did not reveal a significant risk factor for infection. Conclusions: Femoral AVGs are a suitable alternative to upper limb vascular access, with acceptable primary and secondary patency rates. Infection occurred in approximately one-quarter of cases, whereas steal was uncommon.
Secondary Arteriovenous Fistulas: Converting Prosthetic AV Grafts to Autogenous Dialysis Access
Seminars in Dialysis, 2008
As existing arteriovenous grafts (AVGs) fail, the National Kidney Foundation KDOQI Guidelines and the AV Fistula First Breakthrough Initiative (''Fistula First'') project recommend that each patient be re-evaluated for conversion to an arteriovenous fistula (AVF). AVFs created following failure of an AVG have been termed secondary fistulas (SAVF). We review our experience and outcomes converting AVGs to SAVFs, utilizing the mature outflow vein of the AVG when possible, otherwise creating a new AVF at a remote site. We reviewed two groups of consecutive patients undergoing operations for vascular access at different centers. Group 1 had a SAVF protocol in place during the study period with specific criteria for timing SAVF construction. Patients from group 2 were referred for evaluation by nephrologists or dialysis nurses as access problems were recognized, without a formal protocol in place. All patients had preoperative ultrasound or contrast imaging in addition to physical examination. Indications for creating a SAVF were AVG thrombosis, dysfunction, erosion, bleeding, or steal syndrome involving the existing AVG. The simple presence of a functional AVG without evidence of dysfunction was not an indication for conversion to a SAVF. SAVFs were classified according to location and the potential for utilizing the existing mature AVG outflow vein. Group 1: 40 consecutive patients, age 26-78 (mean = 62), 42% were female; 55% were diabetic. These patients had 1-22 previous access operations (mean = 3). 92.5% underwent SAVF surgery prior to loss of the AVG, minimizing catheter use. Cumulative patency was 92.5% at 1 year and 87.5% at 2 years. Group 2: 102 consecutive patients, age 24-87 (mean = 55), 52% were female; 50% were diabetic. These patients had 1-50 previous access operations (mean = 3). Only 19.3% were referred for SAVF surgery prior to loss of the AVG or outflow vein. Cumulative patency was 94.4% at 1 year and 91.6% at 2 years. Failure, dysfunction, or complications of AVGs may be resolved by conversion to a SAVF. Further, the limited lifespan of AVGs and the superiority of AVFs dictates that a plan be in place to transition the AVG patient to an AVF. Most, if not all, hemodialysis patients whose access is an AVG will have one or more anatomic sites and vessels suitable for an autogenous SAVF. Vessel mapping is critical in the evaluation of failing AVGs and in preparation for a SAVF. Cumulative patency rates exceeded 90% at 12 months for SAVFs in both patient groups in this report. The need for catheters was dramatically less in the patient group with an established SAVF conversion plan.
Advanced Biomedical Research
Background: Arteriovenous fi stula (AVF), permanent catheter (PC), and vascular graft are three vascular access types used for hemodialysis procedure. Due to insuffi cient reliable information on the comparison between AVF and PC, this study was conducted to compare AVF and PC regarding dialysis adequacy. Materials and Methods: This prospective study was carried out from March, 2013 to September, 2013. In this study, 76 hemodialysis patients were enrolled and assigned to two unequal groups of AVF and PC. Before and after the dialysis session, blood samples were taken for laboratory examinations and measurement of urea reduction ratio (URR) and Kt/V. The patients were followed up for six months, and then laboratory examinations were repeated. Results: Of the 76 hemodialysis patients, 30 had AVF and others PC. During the 6-month follow-up, 24 patients in PC group but only one patient in AVF group showed infection (P = 0.006), while in each group, three cases of thrombosis were seen (P = 0.58); however, catheter dysfunction was seen in 13 patients of PC group but no patients of AVF group (P = 0.004). There was no difference between the two groups in Kt/V and URR at the beginning of the study; however, after six months, Kt/V and URR were greater in AVF group (P < 0.05). Conclusions: In addition to some advantages of AVF over PC, such as lower rate of infection and thrombosis, we also found better dialysis adequacy in AVF group. We recommend that AVF be created in all of patients with chronic kidney disease who are candidates for hemodialysis.
Journal of vascular surgery, 2015
More than 85% of patients with end-stage renal disease start dialysis through a tunneled dialysis catheter (TDC) for long periods while their arteriovenous fistula or vascular access graft (arteriovenous graft [AVG]) matures. Because TDCs are associated with a high risk of complications, including death and infection, use of an AVG that can be cannulated safely immediately after implantation may reduce morbidity in these patients by allowing earlier TDC removal. We report a prospective multicenter study of a new early-cannulation AVG (Gore ACUSEAL Vascular Graft; W. L. Gore & Associates, Flagstaff, Ariz). Patients requiring creation of a prosthetic vascular access for hemodialysis were enrolled between July 2010 and February 2012 and observed for 12 months. Data were collected on the patients' baseline characteristics; location, position, loss of patency, and revisions of prior AVGs; dialysis sessions using the AVG; and major adverse events related to graft implantation or cannu...