Traditional treatment of infected polytetrafluoroethylene (PTFE) grafts consist of removal of the entire prosthesis. Closure of the native vessels may compromise vascular patency. We examined the outcomes for patients in whom a PTFE remnant of an infected graft was retained on the vessel.
Methods:
We reviewed the operating room log from 2000 to 2011 and identified all patients who had partial removal of an infected PTFE graft used for hemodialysis or peripheral bypass. These patients were examined for subsequent complications.
Results:
Twenty-seven patients underwent 30 partial graft excisions with mean follow-up of 27 months. A total of 17% (5 of 30) of the partial graft resection procedures resulted in complications. Of 48 total remnants left behind at the arterial or venous anastomoses, reinfection occurred in 15%.
Conclusions:
Leaving a well-incorporated small 1-to 5-mm PTFE remnant at the arterial or venous anastomoses can be performed safely with a low risk of complications.
HerreraFAKohanzadehSNasseriYKansalNOwensELBodorR. Management of vascular graft infections with soft tissue flap coverage: improving limb salvage rates--a veterans affairs experience. Management of vascular graft infections with soft tissue flap coverage: improving limb salvage rates--a veterans affairs experience. Am Surg. 2009;75(10):877–881.
2.
SchildAFPerezEGillaspieESeaverCLivingstoneJThibonnierA. Arteriovenous fistulae vs. arteriovenous grafts: a retrospective review of 1,700 consecutive vascular access cases. J Vasc Access. 2008;9(4):231–235.
3.
AkohJA. Prosthetic arteriovenous grafts for hemodialysis. J Vasc Access. 2009;10(3):137–147.
4.
DixFPKhanYAl-KhaffafH. The brachial artery-basilic vein arterio-venous fistula in vascular access for haemodialysis--a review paper. Eur J Vasc Endovasc Surg. 2006;31(1):70–79.
5.
OliverMJMcCannRLIndridasonOSButterlyDWSchwabSJ. Comparison of transposed brachiobasilic fistulas to upper arm grafts and brachiocephalic fistulas. Kidney Int. 2001;60(4):1532–1539.
6.
SzilagyiDESmithRFElliottJPVrandecicMP. Infection in arterial reconstruction with synthetic grafts. Ann Surg. 1972;176(3):321–333.
7.
SeegerJ. Management of patients with prosthetic vascular graft infection. Am Surg. 2000;66(2):166–177.
8.
DixFPKhanYAl-KhaffafH. The brachial artery-basilic vein arterio-venous fistula in vascular access for haemodialysis--a review paper. Eur J Vasc Endovasc Surg. 2006;31(1):70–79.
9.
SchildAFSimonSPrietoJRainesJ. Single-center review of infections associated with 1,574 consecutive vascular access procedures. Vasc Endovascular Surg. 2003;37(1):27–31.
10.
YeagerRAPorterJM. Arterial and prosthetic graft infection. Ann Vasc Surg. 1992;6(5):485–491.
11.
BandykDFBergaminiTMKinneyEVSeabrookGRTowneJB. In situ replacement of vascular prostheses infected by bacterial biofilms. J Vasc Surg. 1991;13(5):575–583.
12.
MooreWSRossonCTHaliADThomasAN. Transient bacteremia: a cause of infection in prosthetic vascular grafts. Am J Surg. 1969;117(3):342–346.
EhrenfeldWKWilburBGOlcottGNStoneyRJ. Autologous tissue reconstruction in the management of infected prosthetic grafts. Surgery. 1979;85(1):82–92.
16.
MertensRAO’HaraPJHertzerNRKrajewskiLPBevenEG. Surgical management of infrainguinal arterial prosthetic graft infections: review of a thirty-five-year experience. J Vasc Surg. 1995;21(5):782–90; discussion 790-791.
17.
GasselHKleinIStegerU. Surgical management of prosthetic vascular graft infection: comparative retrospective analysis of 30 consecutive cases. VASA. 2002;31(1):48–55.
18.
KiktaMJGoodsonSFBisharaRAMeyerJPSchulerJJFlaniganDP. Mortality and limb loss with infected infrainguinal bypass grafts. J Vasc Surg. 1987;5(4):566–571.
19.
BandykDFNovotneyMLBackMRJohnsonBLSchmachtDC. Expanded application of in situ replacement for prosthetic graft infection. J Vasc Surg. 2001;34(3):411–419; discussion 419-20.
SchutteWPHelmerSDSalazarLSmithJL. Surgical treatment of infected prosthetic dialysis arteriovenous grafts: total versus partial graft excision. Am J Surg. 2007;193(3):385–388; discussion 388.
22.
TabbaraMRO’HaraPJHertzerNRKrajewskiLPBevenEG. Surgical management of infected PTFE hemodialysis grafts: analysis of a 15-year experience. Ann Vasc Surg. 1995;9(4):378–384.
23.
WalzPLadowskiJS. Partial excision of infected fistula results in increased patency at the cost of increased risk of recurrent infection. Ann Vasc Surg. 2005;19(1):84–89
24.
SudingPNguyenTGordonIWilsonSE. Glove powder increases Staphylococcus aureus abscess rate in a rat model. Surg Infect (Larchmt). 2010;11(2):133–135.
25.
FreiEHodgkiss-HarlowKRossiPJEdmistonCEJrBandykDF. Microbial pathogenesis of bacterial biofilms: a causative factor of vascular surgical site infection. Vasc Endovascular Surg. 2011;45(8):688–696.
