Role of Brachial Artery Ligation in Management of Prosthetic Arteriovenous Graft Infections.

BACKGROUND: Arteriovenous graft (AVG) infections can present as major life-threatening hemorrhage or sepsis in a chronic kidney disease patient. Frequently, all these patients present in critical condition which need prompt and expeditious management. Various procedures are described for management of infected grafts and its bleeding complications. However, these procedures are associated with postop-operative bleeding and persistent infection. The aim was to study brachial artery ligation (BAL) near the elbow joint in the management of an infected AVG. METHODS: It was a retrospective study where data collection was done for 51 patients who underwent BAL in infected AVGs from January 2007 to December 2016. RESULTS: During the study period, AVG infections were treated in 62 patients. Fifty-one BALs were done in 62 limbs treated. All were arm grafts (brachial artery to axillary vein) using expanded polytetrafluoroethylene grafts. In 49 patients, BAL was done as a primary procedure. In 2 patients, BAL was done after they presented with uncontrolled infection after initial subtotal excision with oversewing of graft stump at arterial anastomosis. There were 36 men and 15 women, with a mean age of 49 years (range, 23-82). The primary etiologies for renal failure were hypertension (56.2%), diabetes (34.3%), and others (9.5%). Follow-up was 100% at 1 month and 82.3% (42 patients) at 3 months, and none showed any signs of ischemia or sepsis. All had biphasic signals in radial and ulnar arteries with normal peripheral capillary oxygen saturation readings in fingers. None of the patients underwent additional interventions. CONCLUSIONS: BAL in AVG infections is a safe alternative considering the critical general condition of chronic kidney disease patient. It reduces the operative time significantly and avoids complex revascularization and anastomotic dehiscence without any ischemic or bleeding complications. BAL near the elbow joint in patients with good back-bleeding can be used as a primary approach in an infected AVG. However, close monitoring of patient in postoperative period is essential.