Surgical management of infected PTFE hemodialysis grafts: analysis of a 15-year experience
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The records of 52 consecutive patients who underwent surgical treatment for 57 episodes of hemodialysis graft infection (HGI) from 1977 to 1993 were reviewed to determine the mortality and morbidity associated with this complication and to clarify guidelines for its management. The study group consisted of 35 women and 17 men whose mean age was 57 years at initial graft placement. Thirty-three (58%) HGIs involved straight grafts in the upper arm, 12 (21%) straight forearm grafts, 11 (19%) loop forearm grafts, and 1 (2%) a loop groin fistula. All of these grafts were constructed with polytetrafluoroethylene (PTFE). All 57 cases of HGI showed at least local evidence and 41 (72%) caused systemic symptoms. Thirty-seven (65%) HGIs were associated with positive blood cultures. The predominant infecting organism wasStaphylococcus,which was isolated alone or in combination with other organisms from 40 (70%) graft or wound sites. Seventy-eight percent (31/40) of the staphylococcal infections involvedStaphylococcus aureus.The median time from graft implantation to diagnosis of HGI was 7 months (mean 16 months, range 0 to 77 months) and from diagnosis to surgical treatment, 4 days (mean 6 days, range 0 to 26 days). Initial surgical management consisted of complete excision of all prosthetic material in 43 (75%) cases and partial excision in 14. The 30-day mortality rate following the last operation for the treatment of HGI was 12% (6/52) and was not significantly increased by incomplete excision. Six (86%) of the early deaths were related to sepsis and each of these patients had positive blood cultures. None of the infected grafts could be salvaged without removal of at least part of the original graft. None of the 43 complete excisions was complicated by recurrent infection at the same time, whereas this complication did occur following six (43%) of the 14 procedures during which residual prosthetic material was left in place (p= 0.00008, Fisher's exact test). Prosthetic HGI is a serious complication that is optimally treated by excision of all infected PTFE. Complete removal of synthetic material offers a significantly reduced risk of recurrent graft sepsis at the same site.
KeywordsPTFE Positive Blood Culture Complete Excision Prosthetic Material Staphylococcal Infection
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- 1.U.S. Renal Data System, 1991 Annual Data Report, The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md., August 1991. V. Survival probabilities and causes of death. Am J Kidney Dis 1991;18:49–60.Google Scholar
- 3.Hinsdale J, Lipkowitz G, Hoover E. Vascular access for hemodialysis in the elderly: Results and perspectives in a geriatric population. Dialysis Transplant 1985;14:560–565.Google Scholar
- 16.Mayers JD, Markell MS, Cohen LS, et al. Vascular access surgery for maintenance hemodialysis. Variables in hospital stay. ASAIO Trans 1992;38:113–115.Google Scholar