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Updated: Nov 18, 2025
Surgical Technique for the Implantation of Tissue Engineered Vascular Grafts and Subsequent In Vivo Monitoring
Published on: April 3, 2015
Application and implications of a standardised reporting system for arteriovenous access graft infection
David Kingsmore1,2, Karen Stevenson2, Andrew Jackson2
1Department of Vascular Surgery, Queen Elizabeth University Hospital, Glasgow, UK.
Introduction:
The perception that arteriovenous graft infection (AVGi) is frequent and severe is not based on contemporary data from large units using modern AVG. Furthermore, older reports compounded misperceptions by using non-standardised reporting that prevents easy comparison against the alternative modalities. The aim of this article is to use a recently published reporting scheme to analyse the frequency, management and outcome of AVGi in a large series of sequential early-cannulation AVG with long-term follow-up.
Methods:
A single-center series analysis was performed of 277 early-cannulation AVG with minimum 1-year follow-up (total 120,082 days). Infections relating to the AVG were classified, root-cause analysed and the outcomes presented.
Results:
Sixteen percent of all AVG implanted (51 episodes) developed infection related to the AVG. Primary AVGi (related to the insertion procedure or within 28 days) occurred in 9 (3%); secondary AVGi (related to AVG in use) occurred 33 times (rate 0.27/1000 haemodialysis days), at a mean of 382 days, and tertiary AVGi (in AVG no longer in use) occurred nine times. Only 1/3 of all AVGi led to bacteraemia, and ½ did not lead to loss of functional access.
Summary:
AVG infection is not common, caused a systemic infection in only one-third, did not lead to metastatic infection, and importantly, was treatable without loss of access in one-half of all cases. Using an objective system that discriminates between aetiology and outcome allows a more complete objective understanding of relative infection risks and outcomes for AVG that can inform discussions with patients requiring vascular access for haemodialysis.
Insights
Arteriovenous graft (AVG) infection is not as common or severe as perceived. Most infections are treatable without losing access, offering a clearer understanding of risks for hemodialysis patients.
Area of Science:
- Nephrology
- Vascular Surgery
- Infectious Diseases
Background:
- Arteriovenous graft (AVG) infection perception may be outdated.
- Older reports lack standardized data for comparison.
- Contemporary data on modern AVG infection is needed.
Purpose of the Study:
- To analyze the frequency, management, and outcomes of AV graft infections.
- To use a standardized reporting scheme for objective analysis.
- To provide contemporary data on early-cannulation AVG infections.
Main Methods:
- Single-center analysis of 277 early-cannulation AV grafts.
- Minimum 1-year follow-up (120,082 days).
- Classification and root-cause analysis of AVG infections.
Main Results:
- 16% of AV grafts developed infection (51 episodes).
- Secondary infections occurred at a rate of 0.27/1000 hemodialysis days.
- One-third of infections led to bacteremia; half were treated without access loss.
Conclusions:
- AVG infection is not common and often not severe.
- Infections are treatable without loss of functional access in 50% of cases.
- Objective reporting enhances understanding of AVG infection risks for hemodialysis access.
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