Surgical treatment of infected prosthetic dialysis arteriovenous grafts: total versus partial graft excision

Background Thirty-five percent of hemodialysis patients with polytetrafluoroethylene grafts lose their access secondary to infection. We hypothesized that partial graft excision (PGE) for infection increases the incidence of vascular anastomotic complications when compared with total graft excision (TGE). Methods The medical records of hemodialysis patients with a polytetrafluoroethylene graft infection from 1994 through 2004 were reviewed for PGE or TGE surgeries. Results A total of 111 infected grafts were managed surgically in 90 patients: 91 grafts by PGE and 20 grafts by TGE. Complication rates were 26.4% versus 5% in the PGE and TGE groups, respectively (P = .038). The incidence of hemorrhage and graft-associated systemic sepsis was similar, whereas the incidence of local infection was increased in the PGE group (19.8% vs. 0%, P = .030). Conclusions Because potential access sites are limited, using PGE to salvage a site, even with a known increased incidence of local infection, represents an acceptable method for the treatment of graft infection.