Risk assessment of significant upper extremity arteriovenous graft infection in the Vascular Quality Initiative

Levin, Scott R.; Farber, Alik; Cheng, Thomas W.; Arinze, Nkiruka; Jones, Douglas W.; Kalish, Jeffrey; Rybin, Denis; Siracuse, Jeffrey J.

doi:10.1016/j.jvs.2019.04.491

Cited by 8 publications

(3 citation statements)

References 31 publications

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“…In our experience, infection is nearly impossible to eradicate using this technique. Although previous studies have demonstrated that incision and drainage alone can be effective in certain patients, the technique is more commonly performed together with partial excision, with or without a new graft interposition, or with total excision [ 20 , 25 , 30 , 31 ]. In addition, a tissue flap can be used to cover the exposed AVG after the removal of damaged skin [ 32 , 33 ]; however, this approach is rarely used, and insufficient evidence exists to support a good prognosis using this technique.…”

Section: Discussionmentioning

confidence: 99%

Pseudomonas aeruginosa Infections Are Associated with Infection Recurrence in Arteriovenous Grafts Treated with Revision

et al. 2023

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Background and Objectives: This study was conducted to investigate whether Pseudomonas aeruginosa (PA) infections of arteriovenous grafts (AVGs) recur more frequently than other bacterial infections following treatment with revision. Materials and Methods: Operative procedures, including total excision, subtotal excision, and revision, were performed on 60 patients to treat 65 AVG infections. Final outcomes were classified as no infection recurrence, infection recurrence, and death without prior recurrence. In the competing risk setting, the cumulative incidence was estimated using the cumulative incidence function and Gray’s test, and the associations between outcomes and different variables were estimated using a subdistribution hazard (SDH) model. Results: Comparing AVG infections with and without recurrence, PA infection was not associated with a higher risk of infection recurrence (p = 0.13); however, the first operative procedure type was associated with infection recurrence (p = 0.04). AVGs with PA infection were associated with a higher total number of surgical interventions (p < 0.05) than AVGs without PA infection. Regarding the cumulative incidences of outcomes, for AVGs treated with subtotal excision or revision, the cumulative incidence of recurrent infection was 3.3-fold higher for those with PA infection than without one year after the first surgery. However, when AVGs were treated with revision alone, the cumulative incidence was 4.1-fold. After excluding AVGs treated with total excision, the SDH model was applied, obtaining a hazard ratio for infection recurrence of 16.05 (p = 0.02) for AVGs with PA infection compared with AVGs without PA infection. No other variables were significantly associated with infection recurrence. Conclusions: For subtotal resection and revision, AVGs infected with PA had a higher recurrence rate than those infected with other species. However, revision surgery may aggravate the recurrence rate.

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Section: Discussionmentioning

confidence: 99%

Pseudomonas aeruginosa Infections Are Associated with Infection Recurrence in Arteriovenous Grafts Treated with Revision

et al. 2023

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“…6 Another small series compared TGE with SGE, where a higher reinfection rate was observed in the SGE group (16.5%) compared to the former (2.3%), but again, robust conclusions are difficult to draw as only a small number had a salvage or graft revision, with four of eight experiencing a reinfection. 10 Utilising the Vascular Quality Initiative (VQI) dialysis access registry from 2011 to 2018, Levin et al 11 reported 49 AVG across the VQI centres and identified several risk factors for AVGi. Female sex and white race were identified as risk factors for early AVGi (within 3 months of implantation), and white race a risk factor for late AVGi (within 1 year of implantation).…”

Section: Discussionmentioning

confidence: 99%

Management of infected arteriovenous grafts for haemodialysis: Outcomes and strategies using a novel objective scoring system

et al. 2023

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Background: In haemodialysis patients with exhausted autogenous options, prosthetic arteriovenous grafts (AVGs) are frequently utilised as tertiary vascular access. However, the prosthetic nature of AVGs precipitates an increased risk of infection which may translate to excess morbidity and life-threatening complications. The current evidence remains divided on the optimal treatment strategy for arteriovenous graft infections (AVGi) with arguments for conservative management by antibiotics, salvaging with graft revision or total/subtotal excision. To address this gap, we assessed the outcomes of AVGi patients treated in our institution, developing an AVGi severity classification model and a proposed treatment algorithm to guide AVGi management. Methods: We conducted a single centre retrospective review of outcomes of patients with AVGi managed either by sole antibiotics therapy, graft revision or surgical excision between June 2016 and May 2021. Outcomes of AVGi patients across differing treatment groups were compared, including 1-year mortality, 6-month and 1-year functional vascular access. We also analysed the outcomes of tunnelled haemodialysis lines (THL), which were used as a temporary vascular access in several AVGi patients in our study. Results: A total of 34 AVGi patients were managed within that time frame and included in the study (5 conservatively management by antibiotics, 5 graft revisions and 24 surgical excision) with a mean age of 60.4 ± 14.4 years (67.6% males). Overall 1-year mortality was 14.7%. A 6-month functional vascular access status across the three groups stood at 60%, 60% and 10% while 1-year functional vascular access status was 60%, 75% and 42% respectively. Conclusions: When clinically appropriate, conservative management by antibiotics or salvage/graft revision can present as prudent AVGi treatment options. The adoption of our proposed severity classification system and treatment algorithm provides a more thorough objective assessment of the infection and helps guide the clinical decision-making process.

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“…Arteriovenous grafts are also required for hemodialysis access creation. With the number of Americans over the age of 60 beginning to increase, effective management of vascular diseases becomes important, because a significant portion of this age group will be affected by vascular diseases [1]. To treat such conditions, various strategies have been developed throughout the years, with vascular prosthesis becoming the gold standard in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Vascular Graft Infections: An Overview of Novel Treatments Using Nanoparticles and Nanofibers

Serpelloni

Alvear

et al. 2022

Fibers

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Vascular disease in elderly patients is a growing health concern, with an estimated prevalence of 15–20% in patients above 70 years old. Current treatment for vascular diseases requires the use of a vascular graft (VG) to revascularize lower or upper extremities, create dialysis access, treat aortic aneurysms, and repair dissection. However, postoperative infection is a major complication associated with the use of these VG, often necessitating several operations to achieve complete or partial graft excision, vascular coverage, and extra-anatomical revascularization. There is also a high risk of morbidity, mortality, and limb loss. Therefore, it is important to develop a method to prevent or reduce the incidence of these infections. Numerous studies have investigated the efficacy of antibiotic- and antiseptic-impregnated grafts. In comparison to these traditional methods of creating antimicrobial grafts, nanotechnology enables researchers to design more efficient VG. Nanofibers and nanoparticles have a greater surface area compared to bulk materials, allowing for more efficient encapsulation of antibiotics and better control over their temporo-spatial release. The disruptive potential of nanofibers and nanoparticles is exceptional, and they could pave the way for a new generation of prosthetic VG. This review aims to discuss how nanotechnology is shaping the future of cardiovascular-related infection management.

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Risk assessment of significant upper extremity arteriovenous graft infection in the Vascular Quality Initiative

Cited by 8 publications

References 31 publications

Pseudomonas aeruginosa Infections Are Associated with Infection Recurrence in Arteriovenous Grafts Treated with Revision

Pseudomonas aeruginosa Infections Are Associated with Infection Recurrence in Arteriovenous Grafts Treated with Revision

Management of infected arteriovenous grafts for haemodialysis: Outcomes and strategies using a novel objective scoring system

Vascular Graft Infections: An Overview of Novel Treatments Using Nanoparticles and Nanofibers

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