Native Arteriovenous Fistula (NAVF) Infections: Case Report and Review of the Literature
Michael F. Amendola, MD, Yasaman Ataei, BA.
VA Medical Center/VCU Health System, Richmond, VA, USA.
OBJECTIVES:
Native arteriovenous fistula (NAVF) creation is considered the best first line approach to patients with end stage renal disease. This perceived advantage of a native artery and vein anastomosis is its relatively low risk of infection. Prosthetic utilization has a high documented risk of infection in the literature1.
METHODS:
We present a case of 45-year old female who presented to our medical center with several day history of altered mental status, fever of 108 degrees, and decreased appetite. Her past medical history was significant for glomerulonephritis secondary to Systemic Lupus Erythematosus (SLE), hypertension, anxiety and basilic vein transposition (BVT) in 2009. Blood cultures obtained grew penicillin-sensitive staphylococcus aureus. The patient was admitted and started on broad spectrum penicillin, her work up found no source of her infection except that of her NAVF. Her NAVF on exam was not tender to examination but did have ulceration. She was taken to the operating room. Upon incision over her BVT the patients vein was found not to be incorporated into surrounding tissue with associated fluid around it. Culture of this fluid failed to identify if the causative agent was like that which she had already had cultured in her blood. Her transthoracic echocardiogram showed no vegetation and she was placed on Cefazolin and discharged from the home. She continues to follow-up in our medical center and refused further access surgery.
RESULTS:
The NAVF is found to carry the lowest risk of infection amongst other forms of hemodialysis access.1 Many times, these cases present with erythema, tenderness, masses and cellulitis2. It is not uncommon for the causative agent not to be cultured.
CONCLUSIONS:
NAVF infection is a rare occurrence when following patients on hemodialysis. It is imperative for the vascular surgeon to keep this infection type in mind especially in the setting of minimal findings at the access site despite generalized symptoms of sepsis. Early exploration and identification of this potential rare infection source if crucial to its management.
Footnotes
1 Nassar GM, Ayus JC. Infectious complications of the hemodialysis access. Kidney Int 60: 1-13, 2001.
2 F.T. Padberg Jr., K.D. Calligaro, A.N. Sidawy. Complications of arteriovenous hemodialysis access: recognition and management. J Vasc Surg, 48, pp. 55S-80S, 2008.
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