Surgical treatment for primary infected aneurysm of the descending thoracic aorta, abdominal aorta, and iliac arteries
Surgical treatment for primary infected aneurysm of the descending thoracic aorta, abdominal aorta, and iliac arteries
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DOI：
10.1067/mva.2002.126557
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发表时间：
2002-10-01
影响因子：
4.3
通讯作者：
Chu, SH
中科院分区：
文献类型：
--
作者：
Hsu, RB;Tsay, YG;Chu, SH
目的和方法。在这篇回顾性综述中，我们报告了在一个中心接受5年以上感染性主动脉瘤治疗的手术结果。结果从1996年10月至2001年10月，19例感染性主动脉瘤患者接受了手术治疗，9例肾上感染（4例近端胸降主动脉瘤，2例远端胸降主动脉瘤和3例肾上腹主动脉瘤）和10例肾下感染（8例肾下腹主动脉瘤和2例髂动脉瘤）。所有患者的血液或组织培养均呈阳性; 89%有发热，89%有白细胞增多，32%血流动力学不稳定。最常见的致病菌是沙门氏菌（74%），其次是链球菌（11%）。10例肾下感染中有9例由沙门氏菌引起。肾下和肾上感染均通过感染主动脉的广泛清创、原位人工移植或补片修复以及长期静脉注射抗生素进行治疗。住院存活率为95%：肾下感染为100%，肾上感染为89%。无围手术期肠缺血或围手术期肢体丧失。2例肾上腺感染患者发生急性肾功能衰竭。3例患者发生晚期死亡，1例早期移植物感染（5%）导致仅有1例4个月时的院内死亡。16例患者在平均随访17.8个月（范围，4-47个月）时仍然存活。没有晚期主动脉或移植物感染。同期，有5名未手术患者，其中4人在住院期间死于休克。结论.感染性主动脉瘤在台湾很常见，沙门氏菌是最常见的致病微生物。通过手术干预和长期静脉注射抗生素，原位移植物置换提供了良好的结局。即使在沙门氏菌感染和原位移植物置换的患者中，人工移植物感染的发生率也很低。
Objective and Method. In this retrospective review, we report the surgical results of infected aortic aneurysms treated at a single center over 5 years. Results. From October 1996 to October 2001, 19 patients with infected aortic aneurysm were treated with surgery, nine with suprarenal infections (four proximal descending thoracic aortic aneurysms, two distal descending thoracic aortic aneurysms, and three suprarenal abdominal aortic aneurysms) and 10 with infrarenal infections (eight infrarenal abdominal aortic aneurysms and two iliac artery aneurysms). All had a positive blood or tissue culture; 89% were febrile, 89% had leukocytosis, and 32% were hemodynamically unstable. The most common responsible pathogens were Salmonella organisms (74%) followed by Streptococcus species (11%). Nine of 10 infrarenal infections were caused by Salmonella organisms. Both infrarenal and suprarenal infections were treated with wide debridement of infected aorta, in situ prosthetic graft or patch repair, and prolonged intravenous antibiotics. Hospital survival rate was 95%: 100% for infrarenal and 89% for suprarenal infections. There was no perioperative intestinal ischemia or perioperative limb loss. Acute renal failure occurred in two patients with suprarenal infection. Late deaths have occurred in three patients with one early graft infection (5%) resulting in the only one in-hospital death at 4 months. Sixteen patients remain alive at mean follow-up of 17.8 months (range, 4-47 months). There have been no late aortic or graft infections. During the same period, there were five unoperated patients, four of whom died of shock during hospitalization. Conclusions. Infected aortic aneurysm is common in Taiwan, and Salmonella species were the most common responsible microorganisms. With surgical intervention and prolonged intravenous antibiotics, in situ graft replacement provided a good outcome. The incidence of prosthetic graft infection was low, even in patients with infections due to Salmonella species and with in situ graft replacement.