Repair of arteriotomy after removal of infected hemodialysis access by venous graft.

Background: Traditionally, extensive prosthetic arteriovenous (AV) graft infection is treated with graft removal and the arteriotomy or the graft stumps were simply sutured following the removal of the graft. However, postoperative bleeding may occur which requires emergent intervention. We report the results achieved at our clinic after arteriotomy repair with venous graft interposition in re-bleeding conditions.

Methods: From January 2000 through February 2001, 31 patients with extensive graft infections underwent graft removal with direct closure of the arteriotomy or graft stumps at our clinic. Seven of these patients experienced re-bleeding from the repaired brachial artery. Six of them received repair of the brachial artery with venous graft interposition and one received brachial artery ligation.

Results: Surgery of the infected dialysis graft removal was associated with a high re-bleeding rate (22.6%) in our group. In this study, we analyzed the preoperative data, including age, gender, incidence of diabetes mellitus, incidence of peripheral artery occlusive disease, and preoperative blood culture. Both univariate and multivariate analyses showed that the positive preoperative blood cultures were the only factors related to postoperative bleeding (Odds Ratio 22.8, p = 0.009 < 0.05). All of the patients that received brachial artery repair with venous graft interposition recovered well.

Conclusion: In the patients with positive blood cultures, we recommended brachial artery repair with venous graft interposition rather than simple closure of the arteriotomy or graft stump after removal of the infected graft. This may prevent re-bleeding due to inadequate debridement and eliminate the possibility of ipsilateral hand ischemia due to brachial artery stenosis following simple closure of the arteriotomy.