Management of Arteriovenous Graft Infection

Objective: Arteriovenous graft (AVG) infection influences the survival and quality of life of patients, causing life-threatening sepsis reducing dialysis access. This study aimed to evaluate an appropriate treatment strategy for AVG infection. Methods: We analyzed 61 cases involving AVG infections identified at a single center. The cases were divided into two groups based on the type of AVG and surgical methods, namely, currently used AVG (cAVG) (n=29) or abandoned AVG (aAVG) (n=32) and total graft excision (TGE) (n=10) or partial graft excision (PGE) (n=46). Results: There was a significant difference in lower procedure frequency (p<0.001) and longer procedure time (p=0.014) in the cAVG group. A significant difference in lower reinfection rate (p=0.009) was found in the TGE group. Multivariable analysis confirmed that aAVG significantly independently affected the reinfection rate (hazard ratio, 2.208; 95% confidence interval, 1.069-4.561; p=0.032). Staphylococcus aureus was the most frequent cause of AVG infection (61.5%); 77.5% of Staphylococcus aureus were methicillin-resistant Staphylococcus aureus. Conclusion: We found a higher risk of reinfection after PGE than TGE, and aAVG infection was associated with approximately two times higher likelihood of reinfection. These findings suggest that TGE should be considered for patients with AVG infections, particularly aAVG infections.