Hsu Ron-Bin, Lin Fang-Yue
Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
Ann Vasc Surg. 2007 Nov;21(6):742-8. doi: 10.1016/j.avsg.2007.01.015. Epub 2007 May 14.
Pathology of infected aortic aneurysm and its clinical correlation have rarely been reported. Between 1995 and 2005, 48 patients with infected aortic aneurysm underwent in situ graft replacement. Twenty-five patients had a suprarenal and 23 patients had an infrarenal infection. The most common responsible pathogen was nontyphoid Salmonella in 32 patients (67%). During operation, gross pus was present in 26 patients (54%). On pathological examination, aortic atherosclerosis was present in all cases, acute suppurative inflammation was present in 31 patients (65%), and bacterial clumps were present in five patients (10%). Positive culture of the aneurysm wall was present in 14 patients (29%). There were 10 patients with prosthetic graft infection (21%) and 12 patients with aneurysm-related death (25%). Although statistically insignificant, local purulent infection with positive culture of the aneurysm wall, gross pus during operation, or acute suppurative inflammation on pathology tended to be associated with high risk of prosthetic graft infection and aneurysm-related death. In conclusion, infected aortic aneurysm occurred in patients with aortic atherosclerosis. On pathology, acute suppurative inflammation was present in the majority of cases but bacterial clumps were not commonly present. Local purulent infection tended to be associated with high risk of prosthetic graft infection and aneurysm-related death.
感染性主动脉瘤的病理学及其临床相关性鲜有报道。1995年至2005年间，48例感染性主动脉瘤患者接受了原位移植物置换术。25例患者为肾上型感染，23例患者为肾下型感染。最常见的病原体是非伤寒沙门氏菌，共32例患者（67%）。手术中，26例患者（54%）有肉眼可见的脓液。病理检查显示，所有病例均存在主动脉粥样硬化，31例患者（65%）存在急性化脓性炎症，5例患者（10%）存在细菌团块。14例患者（29%）动脉瘤壁培养呈阳性。10例患者发生人工血管感染（21%），12例患者死于动脉瘤相关疾病（25%）。尽管无统计学意义，但动脉瘤壁培养阳性的局部化脓性感染、手术中肉眼可见的脓液或病理上的急性化脓性炎症往往与人工血管感染和动脉瘤相关死亡的高风险相关。总之，感染性主动脉瘤发生于主动脉粥样硬化患者。病理上，大多数病例存在急性化脓性炎症，但细菌团块并不常见。局部化脓性感染往往与人工血管感染和动脉瘤相关死亡的高风险相关。
