主动脉覆膜支架感染的管理：移除血管内移植物与保守治疗
The management of aortic stent-graft infection: endograft removal versus conservative treatment.
作者信息
Blanch Montse, Berjón Jennifer, Vila Ramon, Simeon Josep Maria, Romera Antonio, Riera Santiago, Cairols Marc Antoni
机构信息
Department of Angiology and Vascular Surgery, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain.
出版信息
Ann Vasc Surg. 2010 May;24(4):554.e1-5. doi: 10.1016/j.avsg.2009.11.003. Epub 2010 Jan 25.
BACKGROUND
Aortic stent-graft infections (ASGIs) are associated with significant mortality. We report our experience of two cases of ASGI treated differently and successfully.
METHODS
Two patients presented with constitutional symptoms some months after scheduled endovascular repair of aortic aneurysm (EVAR). Patient 1 had an abscess formation around the endograft in continuity with the right groin. Due to patient comorbidities, a conservative treatment was performed. Patient 2 had an abscess formation with air surrounding the stent graft. The patient was treated successfully by endograft removal.
RESULTS
Computed tomographic scan follow-up at 6 months from surgery showed no evidence of recurrent infection.
CONCLUSION
Despite the recommended treatment of ASGI being surgery, conservative treatment can be performed successfully in patients with high surgical risk, avoiding aortic clamping. We present the first reported case of ASGI due to Streptococcus haemolyticus, the second case due to a fungus, and the second reported case of spondylodiscitis after EVAR.
背景
主动脉覆膜支架感染（ASGIs）与显著的死亡率相关。我们报告两例采用不同治疗方法且均成功治疗的ASGI病例的经验。
方法
两名患者在预定的主动脉瘤腔内修复术（EVAR）数月后出现全身症状。患者1在与右腹股沟相连的腔内移植物周围形成脓肿。由于患者存在合并症，故采取保守治疗。患者2在覆膜支架周围形成伴有气体的脓肿。该患者通过移除腔内移植物成功治愈。
结果
术后6个月的计算机断层扫描随访显示无复发感染迹象。
结论
尽管ASGI的推荐治疗方法是手术，但对于手术风险高的患者，可成功进行保守治疗，避免主动脉阻断。我们报告了首例由溶血性链球菌引起的ASGI病例、第二例由真菌引起的病例以及第二例EVAR术后脊椎间盘炎病例。
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