Zhang Ruoyu, Teebken Omke E, Bisdas Theodosios, Haverich Axel, Pichlmaier Maximilian
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
Vascular. 2011 Feb;19(1):34-41. doi: 10.1258/vasc.2010.oa0255.
The coexistence of infected abdominal aortic aneurysms and spondylitis is rare but challenging. The etiology of the infection is frequently unknown. The aim of this study was to review the outcome of surgical repair of this complex disease. From 2004 to 2006, six patients were identified who underwent surgical repair of concomitant infected abdominal aortic aneurysm and spondylitis. Diagnosis, treatment and intermediate-term results are presented. The clinical manifestation included the signs of ongoing systemic infection, neurological deficit and abdominal or back pain. Computed tomography revealed abdominal aortic aneurysms associated with polysegmental spondylitis. Patients underwent radical debridement and aortic replacement with cryopreserved aortic allografts or silver-coated prostheses followed by antibiotic treatment. Only one patient received a simultaneous anterior vertebral stabilization. Greater omentum was placed in the abscess cavity. Intensive care unit and hospital stay averaged 3.0 and 28.0 days, respectively. Organisms were identified in all but one patient. Over a follow-up period of 4.4 years, four patients are alive and showing freedom from infection, and two patients had died unrelated at seven and eight months. In conclusion, surgical repair of infected aortic aneurysms with resection of infected tissues and implantation of a homograft or a silver-coated prosthesis achieved favorable results in this sick patient group. Simultaneous vertebral stabilization is rarely necessary.
感染性腹主动脉瘤与脊柱炎并存的情况罕见但具有挑战性。感染的病因常常不明。本研究的目的是回顾这种复杂疾病手术修复的结果。2004年至2006年，确定了6例接受感染性腹主动脉瘤合并脊柱炎手术修复的患者。现介绍其诊断、治疗及中期结果。临床表现包括持续全身感染的体征、神经功能缺损以及腹部或背部疼痛。计算机断层扫描显示腹主动脉瘤合并多节段脊柱炎。患者接受了根治性清创术，并用冷冻保存的主动脉同种异体移植物或镀银假体进行主动脉置换，随后进行抗生素治疗。只有1例患者同时接受了前路椎体稳定术。将大网膜置于脓肿腔内。重症监护病房和住院时间平均分别为3.0天和28.0天。除1例患者外，所有患者均鉴定出病原体。在4.4年的随访期内，4例患者存活且无感染，2例患者分别在7个月和8个月时非因相关疾病死亡。总之，在这一患病患者群体中，通过切除感染组织并植入同种异体移植物或镀银假体对感染性主动脉瘤进行手术修复取得了良好效果。很少需要同时进行椎体稳定术。
