Department for Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
J Vasc Surg. 2011 May;53(5):1274-1281.e4. doi: 10.1016/j.jvs.2010.11.052. Epub 2011 Feb 2.
The gold standard for the treatment of abdominal aortic infections remains controversial. Cryopreserved arterial homografts and silver-coated Dacron grafts have both been advocated as reasonable grafts. Direct clinical or experimental comparisons between these two treatment options have not been published before. This study compared cryopreserved arterial homografts and silver-coated Dacron grafts for the treatment of abdominal aortic infections in a contaminated intraoperative field.
From January 2004 to December 2009, 56 patients underwent in situ arterial reconstruction for an abdominal aortic infection. Patients with negative intraoperative microbiologic specimens were excluded. We compared 22 of 36 patients (61%) receiving cryopreserved arterial homografts (group A) vs 11 of 20 (55%) receiving a silver-coated Dacron graft (group B). Primary outcomes were survival and limb salvage; secondary outcomes were graft patency and reinfection. Direct costs of therapy were also calculated.
Thirty-day mortality was 14% in group A and 18% in group B (P >.99), and 2-year survival rates were 82% and 73%, respectively (P = .79). After 2 years, limb salvage was 96% and 100%, respectively (P = .50), whereas graft patency was 100% for both groups. Major complications were an aneurysmal degeneration in group A and graft reinfection in group B (n = 2). Median direct costs of therapy (in US $) were $41,697 (range, $28,347-$53,362) in group A and $15,531 (range, $11,310-$22,209) in group B (P = .02).
Our results show comparable effectiveness between cryopreserved arterial homograft and silver-coated Dacron graft in the contaminated operative field with respect to early mortality and midterm survival. Graft-inherent complications, aneurysmal degeneration for homografts, and reinfection for silver graft, were also observed. The in situ arterial reconstruction with homografts is nearly three times more expensive than with silver graft.
腹部主动脉感染的治疗金标准仍存在争议。冷冻保存的动脉同种移植物和涂银的涤纶移植物均被认为是合理的移植物。这两种治疗选择的直接临床或实验比较以前尚未发表过。本研究比较了冷冻保存的动脉同种移植物和涂银的涤纶移植物在污染的术中环境下治疗腹部主动脉感染的效果。
从 2004 年 1 月至 2009 年 12 月，56 例患者因腹部主动脉感染而行原位动脉重建术。术中微生物标本阴性的患者被排除在外。我们比较了接受冷冻保存的动脉同种移植物的 36 例患者中的 22 例（61%）（A 组）与接受涂银的涤纶移植物的 20 例患者中的 11 例（55%）（B 组）。主要结局是生存率和肢体存活率；次要结局是移植物通畅率和再感染。还计算了治疗的直接成本。
A 组的 30 天死亡率为 14%，B 组为 18%（P>.99），2 年生存率分别为 82%和 73%（P=.79）。2 年后，肢体存活率分别为 96%和 100%（P=.50），而两组的移植物通畅率均为 100%。主要并发症为 A 组的动脉瘤样变性和 B 组的移植物再感染（各 2 例）。A 组治疗的直接成本中位数（以美元计）为 41697 美元（范围为 28347 美元至 53362 美元），B 组为 15531 美元（范围为 11310 美元至 22209 美元）（P=.02）。
我们的结果表明，在污染的手术环境中，冷冻保存的动脉同种移植物和涂银的涤纶移植物在早期死亡率和中期生存率方面具有相当的效果。同种移植物的固有并发症（动脉瘤样变性）和涂银移植物的再感染也观察到。同种移植物的原位动脉重建术比涂银移植物贵近三倍。
