Fiorani Paolo, Speziale Francesco, Calisti Annalisa, Misuraca Maria, Zaccagnini Davide, Rizzo Luigi, Giannoni Maria Fabrizia
Department of Vascular Surgery, Policlinico Umberto I, Rome, Italy.
J Endovasc Ther. 2003 Oct;10(5):919-27. doi: 10.1177/152660280301000512.
To investigate the frequency of aortoiliac endovascular graft infections and seek the main factors influencing their development.
To augment personal experience (1 case), a questionnaire was sent to 40 international centers of vascular and endovascular surgery. The literature was also reviewed to collect data on infections developing in endovascular grafts.
The survey (85% response rate) and literature review identified 62 cases of infected endovascular grafts (0.4% frequency of endograft infection). In 22 (35%) patients, the infection manifested initially with vague symptoms only, but 41 (65%) patients eventually presented with abdominal abscess, groin fistula, and septic embolization. Common bacteria, such as Staphylococcus aureus, were identified as the cause of most infections (54.5%). The majority (49, 79%) of the 62 patients were treated surgically; 11 (17.7%) patients received conservative therapy (no therapeutic data in 2 patients). Overall mortality was 27.4% (17/62), and operative mortality was 16.3% (8/49). Conservative treatment led to a mortality rate of 36.4% (4/11). The mean follow-up for all patients was 47.8 weeks. Possible factors influencing the development of an infection were secondary adjunctive procedures, immunosuppression, treatment of false aneurysms, and infected central lines.
Infected endovascular grafts are an urgent problem that has been heretofore underestimated and will probably increase as follow-up lengthens. New techniques should be sought to expedite the diagnosis, and an international registry should be set up to provide validated data.
探讨主-髂动脉血管腔内移植物感染的发生率，并寻找影响其发生发展的主要因素。
为补充个人经验（1例），向40个国际血管和血管腔内手术中心发送了调查问卷。还对文献进行了综述，以收集血管腔内移植物感染的数据。
调查（回复率85%）和文献综述共确定了62例血管腔内移植物感染病例（移植物感染发生率为0.4%）。22例（35%）患者最初仅表现为模糊症状，但41例（65%）患者最终出现腹部脓肿、腹股沟瘘和脓毒性栓塞。常见细菌，如金黄色葡萄球菌，被确定为大多数感染的原因（54.5%）。62例患者中的大多数（49例，79%）接受了手术治疗；11例（17.7%）患者接受了保守治疗（2例患者无治疗数据）。总体死亡率为27.4%（17/62），手术死亡率为16.3%（8/49）。保守治疗导致的死亡率为36.4%（4/11）。所有患者的平均随访时间为47.8周。影响感染发生发展的可能因素包括二次辅助手术、免疫抑制、假性动脉瘤的治疗以及感染的中心静脉导管。
感染的血管腔内移植物是一个此前被低估的紧迫问题，且可能会随着随访时间的延长而增加。应寻求新技术以加快诊断，并建立国际登记系统以提供有效数据。
