Infection of hemodialysis arteriovenous grafts

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' x(2)=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' x(2)=1.123; df=1; p=0.289). Only one death was directly related to AVG infection in this series. Conclusion: 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.