Management of infectious and cutaneous complications in vascular access

Infectious complications in vascular access grafts, primarily seen in those using synthetic graft material, are the major cause of morbidity and mortality in this high-risk group of dialysis-dependent patients. These patients are more prone to infection because of their age, renal failure, and other associated diseases such as diabetes, and they do not fight infections well. This chapter discusses the pathogenesis and bacteriology of these infections and their clinical signs and symptoms. Preventive management can obviate most of these infectious complications and is also outlined. Surgical intervention must be specifically tailored to each patient and their graft, and in many cases alternatives need to be considered.