Infected AV Grafts

 

The Challenge:Remove Infected Graft

  • Up to 35% of AV grafts become infected1

The Solutions: CryoVein® and CryoArtery®

CryoVein and CryoArtery may be placed directly into an infected field to allow healing and revascularization in a single procedure, saving potential future AV access sites.2,3

Allograft Method

Single procedure: save the site2,3

  1. Remove infected AV graft and implant allograft in the same infected site, saving potential future AV access sites
    image-Infected-AV-Grafts-Allograft-1
  2. Insert a temporary dialysis catheter and IV antibiotic therapy
    image-Infected-AV-Grafts-Insert-Heart
  3. Access is possible within 10 to 14 days4,5
    image-Infected-AV-Grafts-Access

VS

Graft Excision Method

Multiple procedures: lose the site2,3

  1. Remove infected AV graft
    image-Infected-AV-Grafts-Graft-1
  2. Insert a temporary dialysis catheter and IV antibiotic therapy
    image-Infected-AV-Grafts-Insert-Heart
  3. After the infection is cleared, perform another operation with a new AV graft in a different location, diminishing potential sites for future AV access
    image-Infected-AV-Grafts-AV-Graft
  4. Access graft at surgeon’s discretion
    image-Infected-AV-Grafts-Access

Allografts for Treating AV Graft Infections:

Re-infection Rates

CryoVein Femoral Vein Patients Treated for AV Graft Infection Re-Infection Rates Follow Up Period
Lin et al.2 36 0% 1 Year
Matsuura et al.4 38 0% 1 Year
Matsuura et al.5 43 2.3% 2 Years
CryoLife Multicenter6 52 3% 2 Years

Cost Comparison:

CryoVein Femoral Vein vs. Graft Excision7

Treatment Methods Patients Average Hospital Stay (p=0.001) Overall Hospital Cost
CryoVein Femoral Vein 20 2.3 days $13,843 ± $6,0007
Graft Excision 13 8.1 days $22,136 ± $12,665

Conclusion: “Cryopreserved femoral vein is a cost-effective means of treating infected AV grafts.”7

A CryoVein Femoral Vein Implant Technique for AV Access

implanttechTo minimize the risk of arterial steal, taper the arterial end of the CryoVein Femoral Vein using an angled cut of the allograft and oversewing the heel of the graft with 6-0 polypropylene suture to create a 4mm2, 5mm5, or 6mm diameter.6

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References

  1. Akoh J. Prosthetic arteriovenous grafts for hemodialysis. J Vasc Access 2009;10:137-47.
  2. Lin P, et al. Management of infected hemodialysis access grafts using cryopreserved human vein allografts. Am J Surg 2002;184:31-6.
  3. Matsuura J. Cryopreserved human femoral vein: a new option for infected access grafts. Contemp Dial & Neph 1999:30-2.
  4. Matsuura J, et al. Cryopreserved femoral vein for difficult hemodialysis access. Ann Vasc Surg 2000;12:50-5.
  5. Matsuura J, et al. Hemodialysis graft infections treated with cryopreserved femoral vein. Cardiovasc Surg 2002. 10;6:561-65.
  6. CryoLife, data on file (ML0101).
  7. Matsuura J, et al. Cost comparison of CryoVein implantation versus graft excision in treating infected hemodialysis grafts. Presented at the 10th Annual Winter Meeting of the Peripheral Vascular Surgery Society, Snowmass, CO. January 14, 2000.

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