The Infection of the Arteriovenous Hemodialysis Access Created with ePTFE Prosthesis. Treatment Based on Experience or on Modern Examinations Findings?

Česká verzia

Authors: P. Bachleda ¹; P. Utíkal ¹; L. Kalinová ¹; J. Zadražil ²; E. Buriánková ³; M. Kolář ⁴
Authors place of work: II. chirurgická klinika FNOL a LF UP v Olomouci, přednosta: doc. MUDr. Petr Bachleda, CSc. ¹; III. interní klinika FNOL a LF UP v Olomouci, přednosta: prof. MUDr. Vlastimil Ščudla, CSc. ²; Klinika nukleární medicíny FNOL a LF UP v Olomouci, přednosta: doc. MUDr. Miroslav Mysliveček, CSc. ³; Ústav mikrobiologie FNOL a LF UP v Olomouci, přednosta: prof. MUDr. Milan Kolář, Ph. D. ⁴
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 1, s. 80-84.
Category: Monothematic special - Original

Summary

The infected ePTFE prosthesis for hemodialysis threatens the patient with local complications such as occlusion, the tunnel infection and massive hemorrhage. These complications are associated with the loss of function of the fistula. Infected prosthesis can work as a source for metastatic infections (endocarditis, arthritis, pneumonia), and sepsis. In European countries, interposition of ePTFE graft usually represents the last option of angioaccess beside the catheterization of central venous system; hence attempts occur to maintain the fistula function despite the manifestation of infection. Authors evaluate the total graftectomy (TGE) and the partial graftectomy (PGE) on the basis of their knowledge and literature findings. They take a stand whether it is preferable to remove an infected graft according to experience or to proceed conservatively following the modern examinations (USG, microbiology, PET CT). According to the documented case-report they tend more to the solution based on experience. If the infection of graft is of gram-negative etiology the total graftectomy (TGE) is recommended.

Key words:
arteriovenous fistula for hemodialysis – ePTFE prosthesis – infection of the prosthesis

Zdroje

1. National Kidney Foundation: Kidney Disease Outcome Quality Initiative (NKFK/DOQI) clinical practice guidelines for vascular access. Am. J. Kidney Dis., 2001; 37(Suppl 1): 137–181.

2. Ether, J., Mendelssohn, D. C., Elder, S. R., et al. Vascular access use and outcomes: an international perspective from the Dialysis Outcomes nad Practice Patterns Study. Nephrol. Dial. Transplant., 2008; 23: 3219–3226.

3. Volder, J. G. R., Kirkham, R. L., Kolff, W. J. AV shunts created in new ways. Trans. Amer. Soc. Artif. Intern. Organs, 1973; 19: 38–42.

4. Baker, L. D., Johnson, J. M., Goldfarb, D. Expanded polytetrafluoroethylene (PTFE) subcutaneous arteriovenous conduit: an improved vascular access for chronic hemodialysis. Trans. Amer. Soc. Artif. Intern. Organs, 1976; 22: 382–387.

5. Berardinelli, L. Grafts and graft materials as vascular substitutes for haemodialysis access construction. Eur. J. Vasc. Endovasc. Surg., 2006; 32: 203–211.

6. Kaufmann, J. L., Garb, J. L., Berman, J. A., et al. A prospective comparison of two expanded polytetrafluoroethylene grafts for linear forearm hemodialysis access: does the manufacturer matter? J. Am. Coll. Surg., 1997; 185: 74–79.

7. Hurlbert, S. N., Maltos, M. A., Henretta, J. F., et al. Long-term patency rates, complications and cost-effectiveness of polytetrafluoroethylene (PTFE) grafts for hemodialysis access: a prospective study that compares Impra versus Gore-tex grafts. Cardiovasc. Surg., 1998; 6: 652–656.

8. Sorom, A. J, Hughes, C. B., McCarthy, J. T., et al. Prospective, randomized evaluation of a cuffed expanded polytetrafluoroethylene graft for hemodialysis vascular access. Surgery, 2002; 132: 135–140.

9. Schild, A. F., Perez, E., Gillaspie, E., et al. Arteriovenous fistulae vs arteriovenous grafts: a retrospective review of 1 700 consecutive vascular access cases. J. Vasc. Access, 2008; 9: 231–235.

10. Zouny, E. W., Dykstra, D. M., Goodkin, D. A., et al. Hemodialysis vascular access preferences at outcomes in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Kidney International, 2002; 61: 2266–2271.

11. Anel, R. L., Yevzlin, A. S., Ivanovich, P. Vascular access and patient outcomes in hemodialysis: questions answered in recent literature. Arteficial Organs, 2003; 27: 237–241.

12. Schwab, S. J., Harrington, J. T., Singh, A., et al. Vascular access for hemodialysis. Kidney Int., 1999; 55: 2078–2090.

13. Vilhelmi, M., Haverich, A. Material used for hemodialysis vascular access: current strategies and a call to action. Graft, 2003; 6: 6–15.

14. Sarnak, M. J., Jaber, B. L. Mortality caused by sepsis in patients with end-stage renal disease compared with the general population. Kidney Int., 2000; 58: 1758–1764.

15. Butterfly, D. W., Schwab, S. J. Dialysis access infection. Curr. Opin. Nephrol. Hypertens, 2000; 9: 631–635.

16. The United States Renal Data System 1999 annual data report. Am. J. Kid. Dis., 1999; 34: 1–176.

17. Lafrance, J. P., Rahme, E., Nedjar, H., et al. Vascular access related infections: definitions, incidence rates, and risk factors. Am. J. Kidney Dis., 2008; 52: 982–983.

18. Raju, S. PTFE grafts for hemodialysis access. Techniques for insertion and management of complications. Ann. Surg., 1987; 206: 666–673.

19. Zibari, G. B., Gadallah, M. R., Landreneau, M., et al. Preoperative vancomycin prophylaxis decreases incidence of postoperative hemodialysis vascular access infections. Am. J. Kidney Dis., 1997; 30: 343–348.

20. Zibari, G. B., Rohr, M. S., Landreneau, M. D., et al. Complications from permanent hemodialysis vascular access. Surgery, 1988; 104: 681–686.

21. Padberg, F. T, Lee, B. C., Curl, L. R., et al. Hemoaccess site infection. Surg. Gynecol. Obstet, 1992; 174: 103–108.

22. Hoen, B., Paul-Dauphin, A., Hestin, D., et al. EPIBACDIAL: A multicenter prospective study of risk factors for bacteremia in chronic dialysis patients. J. Am. Soc. Nephrol., 1998; 9: 869–876.

23. Jaber, B. L. Bacterial infections in hemodialysis patients: Pathogenesis and prevention. Kidney Int., 2005; 67: 2508–2519.

24. Vanholder, R., De Smet, R., Glorieux, G., et al. Review on uremic toxins: Classification, concetration, and interindividual variability. Kidney Int., 2003; 63: 1934–1943.

25. Girndt, M., Sester, U., Sester, M., et al. Impaired cellular immune function in patients with end-stage renal failure. Nephrol. Dial. Transplant., 1999; 14: 2807–2810.

26. Dhingra, R. K., Zouny, E. W., Hulbert-Shearon, T. H., et al. Type of vascular access and mortality in US hemodialysis patients. Kidney Int., 2001; 60: 1443–1451.

27. Minga, T. E, Flanagan, K. H, Allon, M. Clinical consequences of infected arteriovenous grafts in hemodilaysis patients. Am. J. Kidney Dis., 2001; 38: 975–978.

28. Miller, P. E, Carlton, D., Deirhoi, M. H., et al. Natural history of arteriovenous grafts in hemodialysis patients. Am. J. Kidney Dis., 2000; 36: 68–74.

29. Kaplowitz, L. G., Comstock, J. A., Landwehr, D. M., et al. A prospective study of infections in hemodialysis patients: Patients hygiene and other risk factors for infection. Infect. Control Hosp. Epidemiol., 1988; 9: 534–541.

30. Nassar, G. M., Ayus, J. C. Infectious complications of the hemodialysis access. Kidney Int., 2001; 60: 1–13.

31. Curi, M. A., Pallas, P. J., Silva, M. B. Jr., et al. Hemodialysis access: Influence of the human immunodeficiency virus on patency and infection rates. J. Vasc. Surg., 1999; 29: 608–616.

32. Kessler, M., Hoen, B., Mayeux, D., et al. Bacteremia in patients on chronic hemodialysis: a multicenter prospective survey. Neohrom, 1993; 64: 95–100.

33. Allon, M., Depner, T. A., Radova, M., et al. Impact of dialysis dose and membrane on infection-related hospitalisation and death: Results of the HEMO study. J. Am. Soc. Nephrol., 2003; 14: 1863–1870.

34. Bonomo, R. A, Rice, D., Whalen, C., et al. Risk factors associated with permanent access-site infections in chronic hemodialysis patients. Infect. Control Hosp. Epidemiol., 1997; 18: 757–761.

35. Ryan, S. V., Calligaro, K. D., Dougherty, M. J. et al. Management of infected prosthetic dialysis arteriovenous grafts. J. Vasc. Surg., 2004; 39: 73–78.

36. Lentino, J. R, Baddour, L. M., Wray, M., et al. Staphylococcus aureus and other bacteremias in hemodialysis patients: antibiotic therapy and surgical removal of access site. Infection, 2000; 28: 355–360.

37. Wang, S. A, Levine, R. B., Carson, L. A., et al. An outbreak of gram-negative bacteremia in hemodialysis patientsntraced to hemodialysis machine waste drain ports. Infect. Control Hosp. Epidemiol., 1999; 20: 746–751.

38. Bachleda, P., et al. Cévní náhrady v chirurgii arteriovenózních spojek k hemodialýze. Prodos, 2001; 78–81.

39. Palestro, C. J., Vega, A., Kim, C. K., et al. Indium 111 labeled leukocyte scintigraphy in hemodialysis access-site infection. J. Nucl. Med., 1990; 31: 319–324.

40. Musso, G. C., Reynaldi, J., Navarro, M., et al. Hidden clotted vascular access infection diagnosed by fluorodeoxyglucose positron emission tomography. Nephrology, (Carlton), 2008; 13: 264–2655.

41. Lawrence, P. F., Dres, D. J., Alazraki, N., et al. Indium-111-labeled leukocyte scanning for detection of prosthetic vascular graft infection. J. Vasc. Surg., 1985; 2: 165–173.

42. Bhat, T. J., Tellis, V. A., Kohlberg, W. I., et al. Management of sepsis involving ePTFE grafts for hemodialysis access. Surgery, 1980; 87: 445–450.

43. Tailor, B., Sigley, R. D., May, K. J. Fate of infected and eroded hemodialysis grafts and autogenous fistulas. Am. J. Surg., 1993; 165: 632–636.

44. Haug, M. Der komplizierter av shunt infolge aerterieller Probleme. Angioarchiv, 1991; Bd 22: 15–17.

45. Humphries, A. L. Jr., Nesbit, R. R. Jr., Caruana, R. J., et al. Thirty-six recommendations for vascular access operation: lessons learned from our first thousands operations. Am. Surg., 1981; 47: 145–151.

46. Schanzer, A., Ciaranello, A. L., Schanzer, H. Brachial artery ligation with total graft excision is a safe and effective approach to prosthetic arteriovenous graft infection. J. Vasc. Surg., 2008; 48: 655–658.

47. Gifford, R. R. Management of tunnel infections of dialysis PTFE grafts. J. Vasc. Surg., 1985; 2: 854–858.

48. Calligaro, K. D, Veith, F. J., Valladares, J. A., et al. Prosthetic patch remnants to treat infected arterial grafts. J. Vasc. Surg., 2000; 31: 245–252.

49. Wu, M. Y., Ko, P. J., Hsieh, H. C., et al. Repair of arteriotomy after removal of infected hemodialysis access by venous graft. Chang Gung Med. J., 2003; 26: 911–918.

50. Schulte, W. P., Helmer, S. D., Salazar, R., et al. Surgical treatment of infected prosthesis dialysis arteriovenous grafts: total versus partial graft excision. Am. J. Surg., 2007; 193: 385–388

51. Schild, A. F., Simon, S., Prieto, J., et al. Single-center review of infections associated with 1574 consecutive access procedures. Vasc. Endovasc. Surg., 2003; 37: 27–31.

52. Albert, F. J. Clinical considerations in hemodialysis access infection. Adv. Ren. Replace Ther., 2006; 3: 208–217.

53. Ballard, J. L, Bunt, T. J, Malone, J. M. Major complications of angioacces surgery. Am. J. Surg., 1992; 3: 229–232.