Arteriovenous Graft Infection: Clinical Features and Management (original) (raw)

For patients with end-stage renal disease (ESRD) on hemodialysis, the Kidney Disease Outcomes Quality Initiative guidelines recommend vascular access with native arteriovenous fistulas (AVF), endorsing prosthetic arteriovenous grafts (AVG) only when suitable autogenous veins for AVF are lacking. Over the past several decades, there has been considerable pressure to increase AVF placement while decreasing AVG use. In 2017 in the United States, 16% of patients initiated hemodialysis with an AVG, compared with 30% in 2005. A significant concern regarding AVG use is risk of infection, thought to be caused by repeated AVG cannulation. Graft infection accounts for loss of access in over one-third of patients and is associated with mortality and major morbidity, including limb ischemia from compromised arterial supply, endocarditis, and life-threatening sepsis.