What is your approach to cellulitis and erythema over arterial side of prosthetic AV graft for dialysis without purulent discharge after 2 weeks of surgery? Antibiotic or graft excision?
Does the patient exhibit any other signs of infection? Also is there either an elevated white count, or CRP level?
Differentiating between an inflammatory reaction to the PTFE graft versus infection can be tricky. If all you have is erythema in the absence of any systemic markers then I suggest you give a week of antibiotics and continue to observe the situation.
What kind of graft is it? The Atrium Flixene PTFE graft is notorious for causing a brisk cutaneous flare that looks like an infection but isn't an infection. If there is no fever or leukocytosis you can watch and wait for another week or two.
I agree with Dra. Verran; cellulitis and erythema in the skin over the graft, without purulent discharge, no graft exposure and absence or minimal abscess around the graft in the Echo-doppler study can be given a chance with antibiotics and narrow surveillance. But if there´s no improvement or worsening of symptoms, graft excision can´t be delayed so much... anastomotic dehiscence can be very dramatic...
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