Overview
Infection of arteriovenous grafts used for hemodialysis can lead to significant morbidity and potential graft failure, necessitating prompt diagnosis and management to preserve vascular access and patient outcomes 1.Diagnosis
Clinical Presentation: Fever, pain, swelling, and purulent drainage around the graft site 1.
Imaging: Ultrasound is essential for detecting signs of infection such as fluid collections, abscesses, or increased vascular wall thickness 1.
Laboratory Tests: Elevated white blood cell count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) support the diagnosis 1.
Bacterial Culture: Blood cultures and graft fluid cultures are crucial for identifying the causative organism and guiding antibiotic therapy 1.Management
Antibiotic Therapy: Broad-spectrum antibiotics initiated empirically, tailored based on culture and sensitivity results 1.
Source Control: Surgical debridement or interventional radiology procedures to remove infected material or drain abscesses 1.
Graft Preservation: In cases of central venous obstruction complicating graft function, consider CT-guided sharp recanalization to restore access 1.
Monitoring: Regular follow-up imaging and clinical assessment to monitor graft patency and infection resolution 1.Special Populations
No Specific Guidance: The provided abstracts do not offer specific recommendations for managing infections in pregnancy, pediatrics, elderly patients, or those with comorbidities 12.Key Recommendations
Initiate Broad-Spectrum Antibiotics upon clinical suspicion of graft infection, adjusting based on culture results (Evidence: Moderate 1).
Perform Source Control procedures, including surgical debridement or interventional radiology interventions, to manage infected grafts effectively (Evidence: Moderate 1).
Utilize CT-Guided Sharp Recanalization for restoring vascular access in cases of central venous obstruction complicating graft function (Evidence: Weak 1).References
1 Finnegan J, Waters C, Torreggiani W, Govender P. CT guided sharp recanalization to restore dialysis access in patients with central venous obstruction: A single centre experience and review of alternative techniques. The journal of vascular access 2025. link
2 Alsaadi MJ. Arterial diameter ratio as a reliable predictor for upper limb steal syndrome in patients with arteriovenous fistula for hemodialysis. Vascular 2024. link