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This review of 133 arteriovenous (AV) fistulas, created by implantation of polytetrafluoroethylene (PTFE) graft material, reports an infection rate of 16.4% in the first period from 1982 to 1985. The infection rate decreased to 5.6% in the period from 1986 to 1990. Graft infections occurred at a higher rate of 46.2% versus 20% when reoperations because of malfunction, occlusion, aneurysm, or bleeding were necessary. Graft infections can be reduced by the development of standard surgical procedures, by the local and systemic application of antibiotics, and by a careful puncture technique. The treatment of septic graft complications after primary operations resulted in a maintenance of graft function in 50%. After secondary operations the graft had to be excised in all but 1 case.

Infected vascular grafts with aortoenteric fistulae can be difficult to diagnose. We describe an interesting patient who developed hypertrophic osteoarthropathy of the lower extremities. This occurred one year prior to the diagnosis of an infected vascular prosthesis. With definitive surgical therapy, all symptoms of hypertrophic osteoarth ropathy resolved. Patients with arterial prostheses who present with hypertrophic osteoarthropathy should be carefully evaluated for occult graft infections.

This paper reports a patient with a pure Candida albicans vascular graft infection. Presentation was notable for the absence of systemic signs and symp toms of infection, minimal local tissue reaction, and a paucity of organisms in the initial pathologic specimen. The clinical course with multiple episodes of bleeding, the associated pathologic finding of vein necrosis, plus the repeated finding of yeast in tissue sections and in culture implicate the fungus as the cause of local pathology. This paper presents the patient, describes risk factors and possible mechanisms for infection, speculates on the reasons for the rarity of documented candida graft infections, and discusses the implications for patient management.