Isolated arteriovenous dialysis access graft segment infection: The results of segmental bypass and partial graft excision

Arteriovenous (AV) access graft infection results in disruption of dialysis and usually necessitates graft removal when the entire graft is involved. The management of an isolated infected segment of an otherwise noninfected AV access graft, however, remains controversial. To evaluate the utility of segmental bypass and partial graft excision for the treatment of an isolat ed infected AV access graft segment, 17 consecutive cases in 12 patients (7 females/5 males; 14 arm grafts/3 leg grafts; median age = 69 years) were a nalyzed on a vascular teaching service that performed 1244 total access pro cedures from January 1995 through February 1999. Infections presented as a draining sinus or a sinus with hemorrhage emanating from an area over the g raft. At operation, the infected sinus was covered by a transparent occlusi ve dressing and the graft was explored through clean incisions proximal and distal to the infected segment. If the graft was incorporated and free of infection, a piece of expanded polytetrafluoroethylene (ePTFE) was anastomo sed proximally end-to-end and tunneled through noninfected tissues around t he infected sinus. After the distal anastomosis was performed, the skin inc isions were closed and covered with occlusive dressings. The infected graft segment was then removed through the infected sinus wound. The technique o f segmental bypass and partial graft excision results in predictable eradic ation of infection, graft salvage, and maintenance of uninterrupted dialysi s in patients presenting with an isolated AV dialysis access infection. DOI : 10.1007/s100169910011.