The most common complication of grafts is infection. In order to reduce or avoid infections, while placing the graft strict antiseptic rules must be followed and antibiotics administered to the patient. This tactic has significantly reduced the rate of primary infection of the graft. The puncture of the graft must be done carefully and 2-3 weeks must have passed from the date of placement to avoid haematoma. The haematoma is nutritive for the growth of microbes and contributes to the appearance of infections. During puncture of the graft, the field must be sterile, avoiding trauma (Fig. 13.1.9).
Primary infection of the graft is a very serious complication which very often leads to its total removal.
Thrombosis in grafts is common and is a result of:
• The development of fibrosis in the intima at the point of the anastomosis of the vein
• Traumatism during many unsuccessful punctures
• The decrease of arterial blood pressure while using them for haemodialysis
• Low arterial flow due to hypovolaemia.
In such cases surgical exploration should be performed with a Fogarty catheter. When stenosis has developed a new graft is placed. The diagnosis of an occlusion of the graft demands urgent management. The administration of the anti-platelet agents dipyridamole and aspirin often helps to extend graft survival. These agents seem to lower the myointimal layer and avoid the formation of clots at the points of puncture.
Aneurysm formation at the A-V graft is a very serious complication and is usually caused after continuous punctures at the same spot. Their formation is also assisted by a possible coexisting infection. These aneurysms must be dealt with surgically because their existence may endanger the patient's life (Fig. 13.1.10). If an infection does not coexist, then the section of the graft with the aneurysm may be removed or ligated and replaced by a section of a new graft (jump graft) (Fig. 13.1.11).
In conclusion, the best and longest life span of vascular access is the internal A-V shunt and an A-V graft should only be placed if it is completely impossible to create the former.
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