Meta-analysis of total versus partial graft excision: Which is the better choice to manage arteriovenous dialysis graft infection?

Abstract

BACKGROUND: Arteriovenous graft infection (AVGI) is a major cause of hemodialysis access failure. Delayed diagnosis and inappropriate treatment may lead to increased morbidity (3-35%) and mortality up to 12%. OBJECTIVES: Compare the postoperative outcomes of total graft excision (TGE) and partial graft excision (PGE) in the treatment of AVGI. DESIGNS: Systematic review and meta-analysis METHODS: The dataset was defined by searching PubMed, EMBASE, Google Scholar, and the Cochrane database for articles outlining the terms arteriovenous graft infection, infected dialysis graft, TGE and PGE published between 1995-2020. The data analysis evaluated the outcomes of TGE and PGE in the management of AVGI. The meta-analysis was performed using Review Manager Software version 5.4.1. MAIN OUTCOME MEASURES: 30-day mortality, recurrent infection, and reoperation rate. SAMPLE SIZE: Eight studies, including 555 AVGI, and 528 patients. RESULTS: PGE showed a significant increase in recurrent graft infection rate (OR=0.23,95% CI=0.13–0.41, P <.00001) and re-operation rate for control of infection (OR=0.14,95% CI=0.03–0.58, P <.007). However, the 30-day mortality rate did not differ significantly between the groups (OR=0.92,95% CI=0.39–2.17, P =.85). CONCLUSIONS: TGE remains a safe and effective surgical method for the management of AVGI. PGE is associated with a higher risk of graft infection and need for re-operation. As a result, PGE should only be considered in carefully selected patients. LIMITATION: Risk of bias due to the differences in patient characteristics. CONFLICT OF INTEREST: None.