Setacci C, De Donato G, Setacci F, Chisci E, Perulli A, Galzerano G, Sirignano P
Department of Surgery, Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy.
J Cardiovasc Surg (Torino). 2010 Feb;51(1):33-41.
Incidence, clinical presentation and management of aortic grafts infection after open surgical repair are well described in the literature. Infective complications involving endografts after endovascular aneurysm repair (EVAR) have been scarcely investigated, since more attention has been given to the technical aspects of the procedure, including endoleaks, device migration, neck dilatation, endotension and aneurysm rupture. Nevertheless, that is a rare but severe complication occurring after EVAR; potentially difficult to diagnose and treat. Since 1991 only 102 cases of abdominal endograft infections have been reported in the literature. Treatment of infected abdominal endografts is controversial. Although reports have shown that high-risk patients with infected stent grafts treated conservatively with antimicrobial therapy and percutaneous drainage can still survive, most authors agree that an infected endograft should be removed if patient's conditions allow intervention. Standard treatment for infected abdominal endografts includes complete graft excision and local debridement followed by extra-anatomical bypass revascularization or in situ reconstruction with an aortic-bisiliac or bifemoral graft (Dacron or PTFE) or with a homograft. Lower overall mortality was observed for surgical management by explantation of infected endograft followed by in situ replacement as compared to other surgical solutions, but no definitive conclusions can be drawn about the optimal treatment strategy for aortic reconstruction.
开放手术修复后主动脉移植物感染的发病率、临床表现及处理在文献中已有详细描述。血管内动脉瘤修复术（EVAR）后涉及腔内移植物的感染性并发症很少受到研究，因为更多的注意力集中在该手术的技术方面，包括内漏、移植物移位、颈部扩张、内张力和动脉瘤破裂。然而，这是EVAR后发生的一种罕见但严重的并发症；可能难以诊断和治疗。自1991年以来，文献中仅报道了102例腹部腔内移植物感染病例。感染性腹部腔内移植物的治疗存在争议。尽管有报道显示，接受抗菌治疗和经皮引流保守治疗的感染支架移植物高危患者仍可存活，但大多数作者一致认为，如果患者情况允许干预，应取出感染的移植物。感染性腹部腔内移植物的标准治疗包括完全切除移植物和局部清创，然后进行解剖外旁路血管重建或使用主动脉-双髂动脉或双股动脉移植物（涤纶或聚四氟乙烯）或同种异体移植物进行原位重建。与其他手术方案相比，通过取出感染的移植物然后原位置换进行手术治疗的总体死亡率较低，但对于主动脉重建的最佳治疗策略尚无定论。
