Total Resection of Infected Peripheral Hemodialysis Grafts Has a Favorable Impact on Outcomes

Li, Ying-Sheng; Feng, Pin-Chao; Ko, Po‐Jen; Wei, Wen-Cheng; Yu, Sheng‐Yueh; Kao, Tsung-Chi; Hsin, Chun-Hsien; Su, Ta‐Wei

doi:10.1016/j.avsg.2020.07.027

Cited by 2 publications

(4 citation statements)

References 20 publications

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“…AVGs are known to have higher rates of infection than autogenous arteriovenous fistulae. The majority of pathogenic bacteria identified in AVG infections are Gram-positive cocci, and the proportion of PA infections is reported to be < 15% in the majority of studies [ 8 , 9 , 19 , 20 , 21 ]. In some studies of AVG infections, PA infections are not described [ 22 , 23 ], likely because the primary cause of AVG infections is cannulation for dialysis [ 19 , 24 ], although some are also caused by intraoperative contamination.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have indicated that total excision is the ideal treatment option, and the early reconstruction of new hemodialysis access is also recommended [ 8 , 9 , 11 ]. However, in cases of localized infections without signs of systemic involvement, attempting to salvage arteriovenous access through the creation of a new subcutaneous tunnel and restore blood flow using a new graft segment remains a common surgical practice [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…The optimal treatment course for infected AVGs is total excision, which presents with the lowest risk of recurrent infection, whereas revision is considered a less ideal option due to the high rate of recurrent infection [ 8 , 9 ]. However, total excision can be challenging due to the development of severe adhesions, and total excision can lead to bleeding, nerve injury, and arterial stenosis [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…In infected AVGs, Pseudomonas aeruginosa (PA) bacteria is detected at a lower proportion than Gram-positive cocci in many studies [ 8 , 9 , 11 ]. However, the treatment of PA infections remains challenging.…”

Section: Introductionmentioning

confidence: 99%

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Pseudomonas aeruginosa Infections Are Associated with Infection Recurrence in Arteriovenous Grafts Treated with Revision

et al. 2023

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Background and Objectives: This study was conducted to investigate whether Pseudomonas aeruginosa (PA) infections of arteriovenous grafts (AVGs) recur more frequently than other bacterial infections following treatment with revision. Materials and Methods: Operative procedures, including total excision, subtotal excision, and revision, were performed on 60 patients to treat 65 AVG infections. Final outcomes were classified as no infection recurrence, infection recurrence, and death without prior recurrence. In the competing risk setting, the cumulative incidence was estimated using the cumulative incidence function and Gray’s test, and the associations between outcomes and different variables were estimated using a subdistribution hazard (SDH) model. Results: Comparing AVG infections with and without recurrence, PA infection was not associated with a higher risk of infection recurrence (p = 0.13); however, the first operative procedure type was associated with infection recurrence (p = 0.04). AVGs with PA infection were associated with a higher total number of surgical interventions (p < 0.05) than AVGs without PA infection. Regarding the cumulative incidences of outcomes, for AVGs treated with subtotal excision or revision, the cumulative incidence of recurrent infection was 3.3-fold higher for those with PA infection than without one year after the first surgery. However, when AVGs were treated with revision alone, the cumulative incidence was 4.1-fold. After excluding AVGs treated with total excision, the SDH model was applied, obtaining a hazard ratio for infection recurrence of 16.05 (p = 0.02) for AVGs with PA infection compared with AVGs without PA infection. No other variables were significantly associated with infection recurrence. Conclusions: For subtotal resection and revision, AVGs infected with PA had a higher recurrence rate than those infected with other species. However, revision surgery may aggravate the recurrence rate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pseudomonas aeruginosa Infections Are Associated with Infection Recurrence in Arteriovenous Grafts Treated with Revision

et al. 2023

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Meta-analysis of total versus partial graft excision: Which is the better choice to manage arteriovenous dialysis graft infection?

Tullavardhana

Chartkitchareon

2022

Ann Saudi Med

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BACKGROUND: Arteriovenous graft infection (AVGI) is a major cause of hemodialysis access failure. Delayed diagnosis and inappropriate treatment may lead to increased morbidity (3-35%) and mortality up to 12%. OBJECTIVES: Compare the postoperative outcomes of total graft excision (TGE) and partial graft excision (PGE) in the treatment of AVGI. DESIGNS: Systematic review and meta-analysis METHODS: The dataset was defined by searching PubMed, EMBASE, Google Scholar, and the Cochrane database for articles outlining the terms arteriovenous graft infection, infected dialysis graft, TGE and PGE published between 1995-2020. The data analysis evaluated the outcomes of TGE and PGE in the management of AVGI. The meta-analysis was performed using Review Manager Software version 5.4.1. MAIN OUTCOME MEASURES: 30-day mortality, recurrent infection, and reoperation rate. SAMPLE SIZE: Eight studies, including 555 AVGI, and 528 patients. RESULTS: PGE showed a significant increase in recurrent graft infection rate (OR=0.23,95% CI=0.13–0.41, P <.00001) and re-operation rate for control of infection (OR=0.14,95% CI=0.03–0.58, P <.007). However, the 30-day mortality rate did not differ significantly between the groups (OR=0.92,95% CI=0.39–2.17, P =.85). CONCLUSIONS: TGE remains a safe and effective surgical method for the management of AVGI. PGE is associated with a higher risk of graft infection and need for re-operation. As a result, PGE should only be considered in carefully selected patients. LIMITATION: Risk of bias due to the differences in patient characteristics. CONFLICT OF INTEREST: None.

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Total Resection of Infected Peripheral Hemodialysis Grafts Has a Favorable Impact on Outcomes

Cited by 2 publications

References 20 publications

Pseudomonas aeruginosa Infections Are Associated with Infection Recurrence in Arteriovenous Grafts Treated with Revision

Pseudomonas aeruginosa Infections Are Associated with Infection Recurrence in Arteriovenous Grafts Treated with Revision

Meta-analysis of total versus partial graft excision: Which is the better choice to manage arteriovenous dialysis graft infection?

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