Salvage of infected autogenous arteriovenous fistulas, is it possible?

Infection in autogenous arteriovenous fistulas (AVFs) is a critical situation in patients with end stage renal disease (ESRD) that can lead to life threatening rupture or septicemia. To date, no standard guidelines regarding the surgical repair of the infected AVFs is available.

To evaluate the safety and efficacy of the surgical repair in the infected autogenous AVFs.

This prospective study involved 64 ESRD patients who presented with infected autogenous AVFs. Repair of the infected autogenous AVFs was done in 50 cases, while ligation was needed in the other 14 cases. Aneurysmorrhaphy was done in the 26 cases of puncture site infection over venous aneurysms. In 20 cases of AVFs with anastomotic disruption, higher recreation in a proximal clean field (AVF loop anastomosis) was performed, while abscess drainage was done in the remaining four cases presented with non-communicating abscess over the vein. The 14 cases of ligated AVFs included 9 cases of infected ruptured AVFs with active bleeding and 4 cases with non-reconstructable puncture site infection.

After 1 year of follow up, 41 cases (82%) of the repaired AVFs (n = 50) remained patent and functioning as re-infection occurred in 9 cases. Six tunneled permanent catheters were implanted in the 14 cases with ligated AVFs, while the remaining 8 cases had new AVFs established (7 cases of them retained patent AVFs during the follow up period).

Surgical repair of the infected AVFs is an effective procedure that achieves many goals, such as saving patients' lives, maintaining the patency of the native fistula, and avoidance of creation of new AVFs in another site with exhaustion the available veins.