Infection of PTFE grafts used to create arteriovenous fistulas for hemodialysis access.

Between January 1993 and December 1994, we treated 19 patients for infection involving expanded polytetrafluoroethylene (ePTFE) grafts used to create arteriovenous fistulas (AVF) for hemodialysis. Manifestations included false aneurysm in nine cases, periprosthetic abscess in seven cases, and tunnel contamination in three cases. The port of entry was the puncture site or catheter in 63% of cases. The delay to onset of infection was significantly longer in patients with secondary graft infection than in those with postoperative graft infection (7.8 months vs. 1.8 months; p < 0.05). Primary treatment consisted of subtotal resection of all but the juxtaarterial segment of the graft in 12 cases, total resection by resection-anastomosis in 2 cases or ligation of the brachial artery in 2 cases, and conservative treatment with removal of only the infected segment in two cases. Creation of a replacement site was possible in 11 patients (group I) within a mean delay of 3 months (range 1-10 months). Replacement sites were created using another graft in nine cases and a native vein graft in two cases. In 7 patients (group II), creation of a replacement site was not possible due to either intractable infection or unavailability of a suitable native vein graft. The findings of this study support prompt creation of replacement sites after resection of infected prosthetic grafts. Priority should be given to native vein grafts or nonprosthetic alternatives.