In situ revascularization with silver-coated polyester grafts to treat aortic infection: Early and midterm results
In situ revascularization with silver-coated polyester grafts to treat aortic infection: Early and midterm results
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DOI：
10.1016/s0741-5214(03)00554-8
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发表时间：
2003-11-01
影响因子：
4.3
通讯作者：
Simms, M
中科院分区：
文献类型：
--
作者：
Batt, M;Magne, JL;Simms, M
目的：在这项前瞻性研究中，我们分析了腹主动脉感染（霉菌性动脉瘤、假体移植物感染）患者的近期和中期结果，这些患者通过切除动脉瘤或受感染的血管假体并用银涂层聚酯假体进行原位置换来治疗。方法：从 2000 年 1 月到 2001 年 12 月，连续研究了 27 名腹部主动脉感染患者（25 名男性，2 名女性；平均年龄 69 岁）。主动脉感染在七个参与中心被纳入该研究。通过完全（n = 18）或部分（n = 6）切除受感染的主动脉并使用InterGard Silver（IGS）胶原蛋白和醋酸银涂层聚酯移植物进行原位重建来控制感染。结果评估基于生存、保肢、持续或复发感染以及假体移植物通畅。结果：24 例患者出现假体移植物感染，12 例患者出现移植物十二指肠瘘，1 例患者出现移植物结肠瘘；其余3例患者有原发性主动脉感染。大多数培养的生物体毒力较低。 11 名患者 (41%) 紧急放置了 IGS 假体。平均随访时间为 16.5 个月（范围：3-30 个月）。围手术期死亡率为 15%；所有四名死亡患者均患有假体移植物感染。 24 个月的精算生存率为 85%。本系列中没有发现重大截肢事件。仅一名患者（3.7%）出现复发感染。除一名患者外，术后抗生素治疗不超过 3 个月。随访期间未发现假体移植物血栓形成的发生率。结论：本次小系列研究的初步结果表明，IGS 移植物用于治疗低毒力微生物引起的腹主动脉移植物感染和动脉瘤具有良好的效果。需要更大规模的研究和更长时间的随访来比较 IGS 移植物与其他治疗方案在感染部位的作用。
Purpose: In this prospective study we analyzed the immediate and midterm outcome in patients with abdominal aorta infection (mycotic aneurysm, prosthetic graft infection) managed by excision of the aneurysm or the infected vascular prosthesis and in situ replacement with a silver-coated polyester prosthesis.Methods: From January 2000 to December 2001, 27 consecutive patients (25 men, 2 women; mean age, 69 years) with an abdominal aortic infection were entered in the study at seven participating centers. Infection was managed with either total (n = 18) or partial (n = 6) excision of the infected aorta and in situ reconstruction with an InterGard Silver (IGS) collagen and silver acetate-coated polyester graft. Assessment of outcome was based on survival, limb salvage, persistent or recurrent infection, and prosthetic graft patency.Results: Twenty-four patients had prosthetic graft infections, graft-duodenal fistula in 12 and graft-colonic fistula in 1; and the remaining 3 patients had primary aortic infections. Most organisms cultured were of low virulence. The IGS prosthesis was placed emergently in 11 patients (41%). Mean follow-up was 16.5 months (range, 3-30 months). Perioperative mortality was 15%; all four patients who died had a prosthetic graft infection. Actuarial survival at 24 months was 85%. No major amputations were noted in this series. Recurrent infection developed in only one patient (3.7%). Postoperative antibiotic therapy did not exceed 3 months, except in one patient. No incidence of prosthetic graft thrombosis was noted during follow-up.Conclusion: Preliminary results in this small series demonstrate favorable outcome with IGS grafts used to treat infection in abdominal aortic grafts and aneurysms caused by organisms with low virulence. Larger series and longer follow-up will be required to compare the role of IGS grafts with other treatment options in infected fields.