Management of Infected Non-Functioning Femoral AV Grafts

Indications for Removal

Active infection with systemic signs, such as bacteremia, sepsis, or fever, requires urgent removal of the graft and antibiotic therapy, as recommended by the American Journal of Kidney Diseases guidelines 1, 2
Local infection with purulent drainage or abscess formation necessitates surgical exploration and removal of infected graft material, according to the American Journal of Kidney Diseases guidelines 1, 3
Bleeding or threatened rupture at the graft site indicates graft degeneration and requires urgent intervention, as stated in the American Journal of Kidney Diseases guidelines 1, 4
Severe degenerative changes with overlying skin compromise, such as poor eschar formation or spontaneous bleeding, require removal of the graft, as recommended by the American Journal of Kidney Diseases guidelines 4, 5
Subclinical infection manifested as unexplained anemia or systemic inflammatory response may require removal of the graft, as suggested by the American Journal of Kidney Diseases guidelines 3

Infected AV grafts require both antibiotic therapy and surgical removal, as stated in the KDOQI guidelines, because the graft material acts as a foreign body that prevents infection resolution 1, 2
For extensive infection, total graft resection plus antibiotics is required, according to the American Journal of Kidney Diseases guidelines 2, 6
For localized infection, incision and resection of the infected portion may suffice, as recommended by the American Journal of Kidney Diseases guidelines 2, 6
Initial antibiotics should cover Gram-negative, Gram-positive organisms, and Enterococcus, as suggested by the American Journal of Kidney Diseases guidelines 2, 7

Simply thrombosed grafts without signs of infection or other complications do not mandate removal, according to the American Journal of Kidney Diseases guidelines 1, 4
The focus is on treating stenosis and thrombosis to restore function, not automatic removal, as recommended by the American Journal of Kidney Diseases guidelines 3, 5

Do not delay removal of infected grafts, as mortality and morbidity increase substantially with delayed treatment, as stated in the American Journal of Kidney Diseases guidelines 1
Do not assume superficial infection can be treated with antibiotics alone if the graft material is involved, as surgical intervention is required, according to the American Journal of Kidney Diseases guidelines 1, 2
Do not leave retained graft material in cases of infection, as subclinical infection from retained material causes persistent inflammation and epoetin resistance, as suggested by the American Journal of Kidney Diseases guidelines 3