Society For Clinical Vascular Surgery

Back to 2019 ePosters


Risk Assessment of Upper Extremity Arteriovenous Graft Infection in the Vascular Quality Initiative
Scott R. Levin, MD, Alik Farber, MD, Nkiruka Arinze, MD, Thomas W. Cheng, M.S., Douglas W. Jones, MD, Jeffrey A. Kalish, MD, Denis Rybin, Ph.D., Jeffrey J. Siracuse, MD
Boston University, Boston, MA

OBJECTIVES: Infectious complications of arteriovenous grafts (AVG) are a major source of morbidity and mortality. Our aim was to characterize contemporary risk factors for upper extremity AVG infection.
METHODS: The Vascular Quality Initiative (2011-2018) was queried for patients undergoing upper extremity AVG creation. AVG infection was classified as infection treated with antibiotics, incision and drainage (I&D), or graft removal. Univariate, multivariable logistic regression, Kaplan-Meier, and Cox regression analyses were used to evaluate risk factors for 90-day and long-term AVG infection after starting hemodialysis.
RESULTS: Of 1758 upper extremity AVGs, 49 (2.8%) developed infection within 90 days resulting in I&D in 24% and graft removal in 76% of cases. None were managed with antibiotics alone. Patients with AVG infection were more likely to be white and insured; have a history of coronary artery bypass graft and intravenous (IV) drug use; undergo a concomitant vascular procedure; and be discharged on an anticoagulant. In multivariable analysis, 90-day infection was significantly associated with female gender (OR 2.0, 95% CI 1.1-3.8, P=.033), white race (OR 2.3, 95% CI 1.2-4.3, P=.011), IV drug use (OR 5.0, 95% CI 1.7-14.3, P=.003), discharge on an anticoagulant (OR 2.3, 95% CI 1.1-4.7, P=.021), and discharge to a healthcare facility (OR 2.7, 95% CI 1.1-6.6, P=.035). Kaplan-Meier analysis showed that freedom from graft site infection or death at 1 year was 87%. Longer-term graft infection at 1-year follow-up was associated with patients who were white (HR 1.6, 95% CI 1.2-2.1, P=.001), IV drug users (HR 2.0, CI 1.1-3.7, P=.032), and discharged to a healthcare facility (HR 1.9, 95% CI 1.2-3.0, P=.007).
CONCLUSIONS: AVG infection was shown to be uncommon, however the majority required graft removal. Extra care should be taken with high-risk patients and alternative forms of AV access may be considered.


Back to 2019 ePosters