The infection of the arteriovenous hemodialysis access created with ePTFE prosthesis. Treatment based on experience or on modern examinations findings?
Bachleda, P.; Utíkal, P.; Kalinová, L.; Zadrazil, J.; Buriánková, E.; Kolár, M.
Rozhledy V Chirurgii Mesicnik Ceskoslovenske Chirurgicke Spolecnosti 89(1): 80-84
2010
ISSN/ISBN: 0035-9351 PMID: 21351410 Document Number: 639509
The infected ePTFE prosthesis for hemodialysis threatens the patient with local complications such as occlusion, the tunnel infection and massive hemorrhage. These complications are associated with the loss of function of the fistula. Infected prosthesis can work as a source for metastatic infections (endocarditis, arthritis, pneumonia), and sepsis. In European countries, interposition of ePTFE graft usually represents the last option of angioaccess beside the catheterization of central venous system; hence attempts occur to maintain the fistula function despite the manifestation of infection. Authors evaluate the total graftectomy (TGE) and the partial graftectomy (PGE) on the basis of their knowledge and literature findings. They take a stand whether it is preferable to remove an infected graft according to experience or to proceed conservatively following the modern examinations (USG, microbiology, PET CT). According to the documented case-report they tend more to the solution based on experience. If the infection of graft is of gram-negative etiology the total graftectomy (TGE) is recommended.