Management of Arteriovenous Graft Infection

Objective: Arteriovenous graft (AVG) infection influ-ences the survival and quality of life of patients, causing life-threatening sepsis reducing dialysis access. This study aimed to evaluate an appropriate treatment strategy for AVG infection.Methods: We analyzed 61 cases involving AVG infections identified at a single center. The cases were divided into two groups based on the type of AVG and surgical methods, namely, currently used AVG (cAVG) (n= 29) or abandoned AVG (aAVG) (n= 32) and total graft excision (TGE) (n= 10) or partial graft excision (PGE) (n= 46).Results: There was a significant difference in lower pro-cedure frequency (p< 0.001) and longer procedure time (p= 0.014) in the cAVG group. A significant difference in lower reinfection rate (p= 0.009) was found in the TGE group. Multivariable analysis confirmed that aAVG signifi-cantly independently affected the reinfection rate (hazard ratio, 2.208; 95% confidence interval, 1.069-4.561; p= 0.032). Staphylococcus aureus was the most frequent cause of AVG infection (61.5%); 77.5% of Staphylococcus aureus were methicillin-resistant Staphylococcus aureus.Conclusion: We found a higher risk of reinfection after PGE than TGE, and aAVG infection was associated with approxi-mately two times higher likelihood of reinfection. These findings suggest that TGE should be considered for patients with AVG infections, particularly aAVG infections.