Treatment of Polytetrafluoroethylene Hemoaccess Infections

ABSTRACT

PURPOSE: Infection of PTFE hemoaccess is the gravest complication associated with these devices. Infection most commonly results in premature access failure. Other potential complications of graft infections include bleeding, systemic sepsis, limb ischemia from interruption of the arterial supply, bacterial endocarditis, or even death. This study was undertaken to evaluate the major pathogen and the appropriate treatment modality, according to the time of the infection occurrence. METHODS: Between February 1996 and May 2002, sixty PTFE hemoaccess infections were treated by the same surgeon at Soonchunhyang University Hospital. All the patients' records were retrospectively reviewed. RESULTS: Four cases developed a PTFE hemoaccess infection within one month of their construction, and were treated with the total removal and new access formation of the contralateral arm. The other fifty-six cases occurred after one month; twenty-six were treated with the removal and new access formation, eighteen with segmental resection and interposition, seven with incision and drainage, and five with antibiotics only. In the four cases that developed within one month, two developed infectious complications and one died. Whereas, in the fifty-six cases that developed after one month, five cases developed infectious complications and four died. Twenty-four cases of thirty nine graft infections with being checked culture test for bacteria were due to Staphylococcus aureus, with sensitivity to vancomycin. CONCLUSION: The managements of the PTFE hemoaccess infections were influenced by the time the infection occurred. Graft infections that occur within one month should be treated aggressively, with total removal. Infections that occur after one month could be selected for a salvage operation. The causative organism of a graft infection is Staphylococcus aureus, and vancomycin is the drug of choice.