Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Province of China.
J Vasc Surg. 2012 Oct;56(4):943-50. doi: 10.1016/j.jvs.2012.03.018. Epub 2012 May 19.
We sought to determine the safety and efficacy of two different treatment strategies for patients with primary infected aortic aneurysms, including antibiotic treatment alone and endovascular aneurysm repair (EVAR) with aggressive antibiotic treatment, as alternatives to the established treatment of open surgical repair.
We conducted a retrospective chart review of patients who were treated for infected aortic aneurysm without undergoing aortic resection from January 2000 to December 2010 at a single institution.
A total of 40 patients underwent traditional open repair during the study period. Sixteen patients with infected aortic aneurysm (11 men; median age, 70; range, 44-80 years) were identified as not having undergone aortic resection during the 11 years reviewed in the study. Nine patients received antibiotic treatment only (group I) and seven patients underwent EVAR with aggressive antibiotic treatment (group II). Salmonella species were isolated from seven patients in group I, and oxacillin-resistant Staphylococcus aureus was isolated from the remaining two patients. In group II, six patients had blood culture results showing Salmonella species and one patient had a blood culture result showing Escherichia coli. Group I (7 of 9 patients; 78%) had a higher hospital mortality rate than group II (0%; P = .003). Mean follow-up among survivors was 10 ± 15 months (range, 1-37 months). One patient in group II developed a reinfection episode (14%). There was no significant difference between group I (67%; SE, 27.2%) and group II (86%; SE, 13.2%) in the 3-month survival rates (log-rank, P = .39).
Our results support the premise that EVAR is beneficial for the patients with infected aortic aneurysm. Treating an infected aortic aneurysm with antibiotics alone could not stop aneurysm expansion and eradicate the aortic infection before the aneurysm ruptures. For the patients with infected aortic aneurysms who have limited life expectancy and multiple comorbidities, EVAR with aggressive antibiotic treatment should be considered preferentially over antibiotic treatment alone.
我们旨在确定两种不同治疗策略治疗原发性感染性主动脉瘤患者的安全性和有效性，包括单独使用抗生素治疗和血管内动脉瘤修复（EVAR）联合强化抗生素治疗，作为传统开放手术修复的替代方案。
我们对 2000 年 1 月至 2010 年 12 月在一家医疗机构接受治疗但未进行主动脉切除的感染性主动脉瘤患者进行了回顾性图表审查。
在研究期间，共有 40 例患者接受了传统的开放修复。在研究期间回顾的 11 年中，有 16 例感染性主动脉瘤（11 例男性；中位年龄 70 岁；范围 44-80 岁）未进行主动脉切除术。9 例患者仅接受抗生素治疗（I 组），7 例患者接受 EVAR 联合强化抗生素治疗（II 组）。I 组 7 例患者分离出沙门氏菌，2 例患者分离出耐苯唑西林金黄色葡萄球菌。II 组 6 例患者血培养结果显示为沙门氏菌，1 例患者血培养结果显示为大肠埃希菌。I 组（9 例患者中的 7 例；78%）的院内死亡率高于 II 组（0%；P =.003）。幸存者的平均随访时间为 10±15 个月（范围 1-37 个月）。II 组 1 例患者发生再感染（14%）。I 组（67%；SE，27.2%）和 II 组（86%；SE，13.2%）的 3 个月生存率无显著差异（对数秩，P =.39）。
我们的结果支持 EVAR 对感染性主动脉瘤患者有益的前提。单独使用抗生素治疗感染性主动脉瘤不能阻止动脉瘤扩张，也不能在动脉瘤破裂前消除主动脉感染。对于预期寿命有限且合并多种疾病的感染性主动脉瘤患者，应优先考虑 EVAR 联合强化抗生素治疗，而不是单独使用抗生素治疗。
