Clinic for Cardiovascular Surgery, University Hospital of Zurich, Zurich, CH.
Ann Surg. 2011 Nov;254(5):754-59; discussion 760. doi: 10.1097/SLA.0b013e3182365864.
To present the first long-term results of Szilagyi III vascular infections treated by negative pressure wound therapy (NPWT) with graft preservation.
Szilagyi III infections are usually treated by graft/artery excision and secondary vascular/plastic reconstruction. Small series treated with NPWT without graft removal are reported with good short-term to midterm results.
The outcomes of 44 polymorbid patients (mean age = 62 years) with Szilagyi III infections from 2002 to 2009 were analyzed. Thirteen of forty-four required intensive care unit treatment. Forty grafts (prosthetic = 24, vein = 3, biological = 13) and 9 native arteries were involved. Negative pressure wound therapy (VAC; KCI International, Amstelveen, Netherlands) was applied directly on grafts/arteries (negative pressure = 50-125 mm Hg) after radical debridement of infected tissue. Antibiotic treatment was initiated and adapted according to microbiology.
Median duration of NPWT was 33 days (IQR: 20-78), of hospital stay 32 (IQR: 20-82) days. All patients survived 30 days. One-year mortality was 16% (7/44). Long-term mortality after a mean follow-up of 43 months (SD: 21) was 41% (18/44). Complete wound healing was achieved in 91% (40/44). In 37 of 44 patients, grafts were preserved long-term without reinfection. There was no statistically significant difference in outcome between the various graft types involved.
Vascular graft/arterial preserving treatment with NPWT in Szilagyi III infections was safe and effective with a very low short-term mortality. The majority of infected grafts were preserved without reinfection during a mean long-term follow-up of 4 years. This new treatment algorithm avoids major reconstructive surgery and should be used when dealing with Szilagyi III vascular infections.
介绍采用负压伤口治疗（NPWT）保存移植物治疗 Szilagyi III 型血管感染的初步长期结果。
Szilagyi III 型感染通常采用移植物/动脉切除和二次血管/整形重建治疗。有报道称，采用 NPWT 治疗而不切除移植物的小系列病例，其短期至中期结果良好。
分析了 2002 年至 2009 年 44 例多合并症患者（平均年龄=62 岁）Szilagyi III 型感染的结果。44 例患者中有 13 例需要重症监护治疗。涉及 40 个移植物（假体=24 个，静脉=3 个，生物=13 个）和 9 根原生动脉。在彻底清创感染组织后，直接在感染的移植物/动脉上应用负压伤口治疗（VAC；KCI International，Amstelveen，荷兰）（负压=50-125mmHg）。根据微生物学结果开始并调整抗生素治疗。
NPWT 的中位持续时间为 33 天（IQR：20-78），住院时间为 32 天（IQR：20-82）。所有患者均在 30 天内存活。1 年死亡率为 16%（7/44）。平均随访 43 个月（SD：21）后的长期死亡率为 41%（18/44）。44 例患者中，91%（40/44）实现了完全伤口愈合。在 44 例患者中，有 37 例长期保存的移植物未再感染。涉及的各种移植物类型之间的结果无统计学显著差异。
在 Szilagyi III 型感染中，采用 NPWT 保存血管移植物/动脉的治疗是安全有效的，短期死亡率非常低。在平均 4 年的长期随访中，大多数感染的移植物未再感染。这种新的治疗方案避免了主要的重建手术，应在处理 Szilagyi III 型血管感染时使用。
