Program Book - Keck School of Medicine of USC - University of ...

Dialysis Graft InfectionSummary• Management strategy determined by:• Extent and timing of infection• Severity of systemic sepsis• Availability of other access sites• Total and subtotal excision most effective ineradicating infection but require catheter andnew access site• Partial excision & preservation preserves accesssites, avoid catheters but is associated with 20 –25% recurrence rate• Requires close monitoring• 6 weeks of culture directed antibioticsInfected Autogenous DialysisFistulas• Rare, S. aureus pre-dominant organism• Usually due to erosion of aneurysmthrough skin or necrosis at puncture site• Contamination vs Infection• Excision/reconstruction with or withoutinterposition graft preferred treatment• Recent reports of covered stents inabsence of gross infectionEndovascular Therapy ofAneurysmal AV fistulas• Shemesh, et al, J Vasc Surg,2011• 20 patients with aneurysmsand graftpseudoaneurysms, 6erosions (Viabahn)• 87% patency at 1 year withno infections• Shah, et al, J Vasc Surg, 2012• 24 patients, 8 witherosions, 3 failed due toinfection (Viabahn)107