Operative Treatment of Septic Hemorrhage Due to Dialysis Arterio-Venous Fistula
Languages of publication
The number of hemodialyzed patients in western countries is growing consistently. Septic complications of vascular access obtained with artificial prostheses are a significant therapeutic problem. Septic bleeding from infected arterio-venous fistula is a life-threatening condition.The aim of the study was to evaluate the results of treatment for septic bleeding from arterio-venous fistula. Data was gathered at the General, Vascular Department at Central Clinical Hospital Ministry of Internal Affairs.Material and methods. Between January 12004 and December 31, 2008, we noticed septic bleeding caused by infectious complications of dialysis fistula in 6 of 348 patients who underwent operation for arterio-venous fistula.Results. All of the patients with septic bleeding had arm fistula due to the employment of vascular prostheses. Successful dialysis fistula reconstruction was performed in 5 of 6 patients. Reconstruction of the brachial artery was carried out in the sixth patient. In all cases, we used segments of autogenous saphenous vein as reconstructive material. Patients with septic bleeding were significantly more likely to have undergone a vascular access operation or fistula reconstruction, in comparison to the group of non-septic patients.Conclusions. The highest risk of septic bleeding as a result of dialysis fistula infection is observed in patients with fistulas preformed with vascular prosthetic grafts. Patients operated due to septic bleeding have the possibility to maintain existing vascular access for dialysis. Our results indicate that the best material for infected dialysis fistula reconstruction is autogenous saphenous vein.
1 - 3 - 2010
15 - 9 - 2010
- US Renal Data Systems: USRDS 2003 Annual Data Report: Atlas of End-Stage Renal Disease in the United States, Bethesda, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, 2003.
- Maillaux L, Belluci A, Wilkes B et al.: Mortality in dialysis patients: analysis of the causes of Health. Am J Kidney Dis 1991; 18: 326-35.
- Nassar G, Ayus J: Infectious complications of the hemodialysis Access. Kidney Int 2001; 60: 1-13.[Crossref][PubMed]
- Tabbara M, O'Hara P, Hertzer N et al.: Surgical management of infected PTFE hemodialysis grafts: analysis of a 15-year experience. Ann Vasc Surg 1995; 9: 378-84.
- Anderson JE, Chang AS, Anstadt MP: Polytetrafluoroethylene hemoaccess site infections. ASAIO J 2000; 46: 18-21.[Crossref]
- Minga TE, Flanagan KH, Allon M: Clinical consequences of infected arteriovenous grafts in hemodialysis patients. Am J Kid Dis 2001; 38: 975-78.[Crossref]
- Stevenson KB: Management of hemodialysis vascular access infections. In: Gray RJ, Sands JJ, eds. Dialysis Access: A Multidisciplinary Approach. Philadelphia: Lippincott Williams & Wilkins; 2002: 98-106.
- Denueville M: Infection of PTFE grafts used to create arteriovenous fistulas for hemodialysis access. Ann Vasc Surg 2000; 14: 473-79.[Crossref]
- Fong I, Capellan J, Simbul M et al.: Infection of arterio-venous fistulas created for chronic haemodialysis. Scand J Infect Dis 1993; 25: 215-20.[Crossref]
- Schanzer A, Ciaranello AL, Schanzer H: Brachial artery ligation with total graft excision is a safe and effective approach to prosthetic arteriovenous graft infections. J Vasc Surg 2008; 48: 655-58.[PubMed][Crossref][WoS]
- Lin PH, Brinkman WT, Terramani TT et al.: Management of infected hemodialysis access grafts using cryopreserved human vein allografts. Am J Surg 2002; 184: 31-36.[Crossref]
- Iseneberg JS: Let it be: salvage of expose hemodialysis grafts with fascio-cutaneous island flaps. Microsurgery 2004; 24: 134-38.[Crossref]
- McAllister TN, Maruszewski M, Garrido SA et al.: Effectiveness of haemodialysis access with an autologous tissue-engineered vascular graft: a multicentre cohort study. Lancet 2009; 373: 1440-46.[WoS]
- Kurimoto Y, Tsuchida Y, Saito J et al.: Emergency endovascular stent-grafting for infected pseudoaneurysm of brachial artery. Infection 2003; 31: 186-88.
- Zibari G, Gadallah M, Landreneau M et al.: Preoperative vancomysin prophylaxis decrease incidence of postoperative hemodialysis vascular Access infections. Am J Kidney Dis 1997; 30: 343-48.[Crossref]
- Schwab D, Taylor S, Cull D et al.: Isolated Arteriovenous Dialysis Access Graft Segment Infection: The Results of Segmental By-pass and Partial Graft Excision Ann Vasc Surg 2000; 14: 63-66.
- Ceppa EP, Sileshi B, Beasley GM, Lawson JH: Surgical excision of infected arteriovenous grafts: technique and review. J Vasc Access 2009; 10: 148-52.[PubMed]
- Shutte W, Helmer S, Salazar B et al.: Surgical treatment of infected prosthetic dialysis arteriovenous grafts: total versus partial graft excision. Am J Surg 2007; 193: 385-88.[Crossref]
- Walz P, Ladowski JS: Partial excision of infected fistula results in increased patency at the cost of increased risk of recurrent infection. Ann Vasc Surg 2005; 19: 84-89.[PubMed][Crossref]
- Bonomo RA, Rice D, Whalen C et al.: Risk factors associated with permanent Access-site infections in chronic hemodialysis patients. Infect Control Hosp Epidemiol 1997; 18: 757-61.
- Boelaert J, Van Landuyt H, Godard C et al.: Nasal mupirocin ointment decreases incidence of Staphylococcus aureus bacteraemia in haemodialysis patients. Nephrol Dial Transplant 1993; 8: 23 5-239.
Publication order reference