Bell Christopher L, Ali Ahsan T, Brawley John G, D'Addio Victor J, Modrall J Gregory, Valentine R James, Clagett G Patrick
Department of Surgery, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75235, USA.
J Am Coll Surg. 2005 Jun;200(6):831-6. doi: 10.1016/j.jamcollsurg.2005.02.012.
Infected femoral artery pseudoaneurysms (IFAPs) secondary to percutaneous arterial access, injection of illegal substances, and from infected synthetic grafts, appear to be increasing in incidence. Ligation of IFAPs without revascularization offers control of infection but may risk limb ischemia. Revascularization with extraanatomic synthetic grafts may risk reinfection and abrupt thrombosis. Excision of IFAPs with revascularization using superficial femoral popliteal vein (SFPV) provides both control of infection and excellent limb perfusion.
A retrospective review was conducted of patients diagnosed with IFAP who underwent resection and revascularization with SFPV at a single medical center. Outcomes measured included reinfection and amputation rate. These were compared with other series using various methods to treat IFAPs.
Eleven patients with IFAP were encountered from 1992 to 2004. Mean age was 64 years (+/-10 SD). Five patients developed IFAP secondary to percutaneous arterial access procedures. Four patients developed infected femoral artery pseudoaneurysms secondary to synthetic graft infection. Two patients developed IFAP secondary to injection of illegal substances in the femoral region. All patients had positive wound cultures initially. Staphylococcus was the most common organism found in wound cultures. All patients underwent resection of IFAP with lower extremity revascularization using SFPV. There was no incidence of limb ischemia and no perioperative deaths in this series.
Excision of IFAP with revascularization can be successfully achieved using SFPV. This method may prove to be superior to other methods with apparent higher patency rates and resistance to reinfection.
继发于经皮动脉穿刺、非法药物注射以及感染的人工血管的感染性股动脉假性动脉瘤（IFAP）的发病率似乎在上升。不进行血管重建的IFAP结扎术可控制感染，但有肢体缺血的风险。采用解剖外人工血管进行血管重建可能有再次感染和突然血栓形成的风险。使用股浅腘静脉（SFPV）进行血管重建切除IFAP既能控制感染，又能提供良好的肢体灌注。
对在单一医疗中心接受SFPV切除和血管重建的IFAP患者进行回顾性研究。测量的结果包括再次感染率和截肢率。将这些结果与使用各种方法治疗IFAP的其他系列研究进行比较。
1992年至2004年共遇到11例IFAP患者。平均年龄为64岁（标准差±10）。5例患者继发于经皮动脉穿刺操作后发生IFAP。4例患者继发于人工血管感染后发生感染性股动脉假性动脉瘤。2例患者继发于股部非法药物注射后发生IFAP。所有患者最初伤口培养均为阳性。葡萄球菌是伤口培养中最常见的病原体。所有患者均接受了IFAP切除及使用SFPV进行下肢血管重建。本系列中无肢体缺血发生，也无围手术期死亡。
使用SFPV可成功实现IFAP切除并进行血管重建。该方法可能优于其他方法，其通畅率明显更高，且抗再次感染能力更强。
