Experience with Covered Stents for the Management of Infected Arteriovenous Grafts
Nicholas J. Gargiulo, III, MD FACS RVT RDMS RPVI, Frank J. Veith, MD FACS, Larry Scher, MD FACS, Evan Lipsitz, MD FACS, Neal Cayne, MD FACS.
Clinch Valley Health, Richlands, VA, USA.
Introduction: The traditional management of infected arteriovenous dialysis access with aneurysmal or pseudoaneurysmal degeneration and bleeding involves removal of all or part of the graft. We report a series of patients who had overt signs of infection and bleeding and were managed with graft preservation.Methods: Five patients presented with bleeding aneurysm or pseudoaneurysm of arteriovenous grafts. Each access had overt signs of infection including ulceration and surrounding erythema. One patient had staphylococcus aureus positive blood cultures two days prior to presentation. All patients underwent percutaneous fistulogram and placement of a covered self-expanding stent covering the area of graft defect. All patients were then administered intravenous antibiotics on dialysis for 2-6 weeks after intervention.Results: All 5 grafts were preserved and used immediately for dialysis access. There were no procedure related complications. One patient developed respiratory distress secondary to aspiration on postoperative day 1. Another patient developed late signs of systemic infection. One patient with preoperative bacteremia had positive blood cultures post intervention and required complete graft excision.Conclusion: Bleeding arteriovenous grafts with local signs of infection can be managed with graft preservation in select cases. It appears that positive blood cultures may preclude graft salvage.
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