Infected aneurysms of the infrarenal abdominal aorta: Diagnostic criteria and therapeutic strategy
Infected aneurysms of the infrarenal abdominal aorta: Diagnostic criteria and therapeutic strategy
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DOI：
10.1007/s100169900075
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发表时间：
1997-09-01
影响因子：
1.5
通讯作者：
Guidicelli, H
中科院分区：
文献类型：
--
作者：
Sessa, C;Farah, I;Guidicelli, H
从1976年至1994年，我们施行了18例肾下腹主动脉感染性动脉瘤的手术治疗。9名患者的动脉瘤破裂：6名患者进入腹膜后腔，3名患者进入相邻结构（十二指肠、下腔静脉、左肾静脉）。2例患者伴有脊柱炎。4例患者在手术治疗时休克。6例患者（包括4例沙门氏菌感染患者和2例脊柱炎患者）术前血培养阳性。沙门氏菌是最常见的微生物（27%）。厌氧菌占16%。原位置换术13例，其中3例在急性化脓性感染情况下进行。5例患者行解剖外旁路术。2例患者（11%）因感染性并发症（1例患者主动脉吻合口破裂，1例患者主动脉残端破裂）发生术后早期死亡。所有存活患者均接受了至少6周的长期抗生素治疗。继发于动脉瘤感染的总体死亡率为16%。4名患者（38%）发生主动脉移植物感染，包括2名沙门氏菌感染患者和1名脊柱炎患者。1例患者术后6个月发生假性吻合口动脉瘤，并通过原位动脉同种异体移植物置换术进行治疗。2例脊柱炎患者术后血培养阳性，其中1例发生主动脉假体感染。除破裂外，预后不良的因素包括脊柱炎和沙门氏菌感染，发现这些因素大大增加了原位重建术后移植物感染的风险。
From 1976 to 1994 we performed surgical treatment of 18 infected aneurysms of the infrarenal abdominal aorta. The aneurysm had ruptured in nine patients: into the retroperitoneum in six patients, and into an adjacent structure in three patients (duodenum, inferior vena cava, left renal vein). Two patients had an associated spondylitis. Four patients were in shock at the time of surgical treatment. Six patients (including four patients with Salmonella infection and two patients with spondylitis) had positive preoperative blood cultures. Salmonella was the most common microorganism (27%). Anaerobes accounted for 16%. In situ replacement was performed in 13 patients including three procedures performed under emergency conditions with frank purulent infection. Extraanatomic bypass was performed in five patients. Early postoperative death occurred in two patients (11%) due to septic complications (rupture of aortic anastomosis in one patient and rupture of aortic stump in one patient). All surviving patients underwent prolonged antibiotic therapy for at least 6 weeks. Overall mortality secondary to infected aneurysm was 16%. Infection of the aortic graft occurred in four patients (38%) including two patients with Salmonella infection and one patient with spondylitis. One patient developed a false anastomotic aneurysm 6 months postoperatively and was treated by in situ arterial allograft replacement. Postoperative blood cultures were positive in two patients presenting spondylitis and infection of the aortic prosthesis occurred in one of these patients. In addition to rupture, poor prognostic factors included spondylitis and Salmonella infection that were found to greatly enhance the risk of postoperative graft infection following in situ reconstruction.