Surgical management of infected PTFE hemodialysis grafts: analysis of a 15-year experience

Marwan Tabbara, Patrick J. O'Hara, Norman R. Hertzer, Leonard P. Krajewski, Edwin G. Beven

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)378-384
Number of pages7
JournalAnnals of Vascular Surgery
Volume9
Issue number4
DOIs
StatePublished - Jul 1 1995
Externally publishedYes

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Polytetrafluoroethylene
Renal Dialysis
Transplants
Infection
Forearm
Sepsis
Staphylococcal Infections
Mortality
Groin
Fistula

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Surgical management of infected PTFE hemodialysis grafts : analysis of a 15-year experience. / Tabbara, Marwan; O'Hara, Patrick J.; Hertzer, Norman R.; Krajewski, Leonard P.; Beven, Edwin G.

In: Annals of Vascular Surgery, Vol. 9, No. 4, 01.07.1995, p. 378-384.

Research output: Contribution to journalArticle

Tabbara, Marwan ; O'Hara, Patrick J. ; Hertzer, Norman R. ; Krajewski, Leonard P. ; Beven, Edwin G. / Surgical management of infected PTFE hemodialysis grafts : analysis of a 15-year experience. In: Annals of Vascular Surgery. 1995 ; Vol. 9, No. 4. pp. 378-384.
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abstract = "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.",
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