Vogt Paul R, Brunner-LaRocca Hans-Peter, Lachat Mario, Ruef Christian, Turina Marko I
Department of Cardiovascular Surgery, Division of Cardiology, University Hospital, Zurich, Switzerland.
J Vasc Surg. 2002 Jan;35(1):80-6. doi: 10.1067/mva.2002.118818.
In situ repair with cryopreserved vascular allografts improves the results in the surgical treatment of aortic infection. This study evaluated the technical pitfalls with the use of allografts that influence early and midterm mortality.
Between 1990 and 1999, 49 patients, 21 (43%) with a mycotic aneurysm and 28 (57%) with a prosthetic graft infection of the thoracic and abdominal aorta including pelvic and groin vessels, underwent in situ repair with cryopreserved arterial allografts. Seventeen patients (35%) had aortobronchial, aortoesophageal, or aortoenteric fistulas.
Allograft-related technical problems occurred in eight patients (16%) in this series, and they included: intraoperative rupture caused by allograft friability; allograftenteric fistula from ligated allograft side branches rupturing 8, 18, and 48 months after implantation; anastomotic failure caused by inappropriate mechanical stress; anastomotic stricture after partial replacement of infected prosthetic grafts; allograft failure caused by inappropriate wound drainage; and recurrence of infection after inappropriate duration of antifungal treatment. Seven of the eight technical problems (87%) occurred in the first 10 patients (80%) in this series. There was one technical failure in the remaining 39 patients (2.6%; P =.0002) because of various technical adaptations, such as critical selection of allografts, use of allograft strips supporting large anastomoses, sealing with antibiotic-impregnated fibrin glue, and change in technique of allograft side-branch ligature. The 30-day mortality rate was 6% for the whole series; however, it was 2.6% for last 39 patients, with no recurrence of infection or allograft-related late death.
In situ repair with cryopreserved arterial allografts achieves excellent early and late results in the treatment of aortic infection. However, distinct allograft-related technical problems had to be overcome to improve the outcome of patients with major vascular infections.
使用冷冻保存的血管同种异体移植物进行原位修复可改善主动脉感染的手术治疗效果。本研究评估了使用同种异体移植物时影响早期和中期死亡率的技术陷阱。
1990年至1999年间，49例患者接受了使用冷冻保存的动脉同种异体移植物进行的原位修复，其中21例（43%）患有真菌性动脉瘤，28例（57%）患有胸主动脉和腹主动脉包括盆腔和腹股沟血管的人工血管感染。17例患者（35%）存在主动脉支气管、主动脉食管或主动脉肠瘘。
本系列中有8例患者（16%）出现了与同种异体移植物相关的技术问题，包括：同种异体移植物易碎导致术中破裂；植入后8、18和48个月，结扎的同种异体移植物侧支破裂导致同种异体移植物肠瘘；不适当的机械应力导致吻合失败；感染的人工血管部分置换后吻合口狭窄；伤口引流不当导致同种异体移植物失败；抗真菌治疗时间不当导致感染复发。这8个技术问题中的7个（87%）发生在本系列的前10例患者（80%）中。其余39例患者中有1例技术失败（2.6%；P = 0.0002），原因是进行了各种技术调整，如严格选择同种异体移植物、使用支持大吻合口的同种异体移植物条带、用含抗生素的纤维蛋白胶密封以及改变同种异体移植物侧支结扎技术。整个系列的30天死亡率为6%；然而，最后39例患者的死亡率为2.6%，无感染复发或与同种异体移植物相关的晚期死亡。
使用冷冻保存的动脉同种异体移植物进行原位修复在主动脉感染的治疗中取得了优异的早期和晚期效果。然而，必须克服与同种异体移植物相关的明显技术问题，以改善主要血管感染患者的治疗结果。
