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[自体原位重建破裂性霉菌性腹主动脉瘤患者的主动脉分叉——病例报告]

[Autologous in situ reconstruction of aortic bifurcation in a patient with ruptured, mycotic abdominal aneurysm--case report].

作者信息

Hapka Łukasz, Halena Grzegorz

出版信息

Pol Merkur Lekarski. 2014 Feb;36(212):109-12.

Abstract

Primarily infected aortic aneurysms represent a small percentage (0.7-1.31%) of abdominal aortic aneurysms. In this paper, we present a case of a 57-year-old man who was admitted to hospital because of abdominal pain and accompanying fever. Initial diagnosis revealed rupture of aortic bifurcation and the patient was qualified for surgical treatment. Intraopeatively, we encountered ruptured aneurysm of aortic bifurcation, additionally we discovered features of infection (cultures revealed Staphylococcus aureus spp.), which precluded the use of a dacron prostheis. Due to the stable hemodynamic status of the patient, we decided to perform "in situ" aorto-iliac reconstruction using deep vein harvested from the single lower limb. Such procedures are rarely performed on an emergency basis, however, potential benefits may outweigh the risk of a more technically challenging procedure. In the postoperative course antimicrobial treatment against Staphylococcus aureus was continued for 12 weeks after surgery. There has been a good long-term patency during more than 5 years of follow-up with no signs of reinfection or degeneration of the graft.

摘要

原发性感染性主动脉瘤占腹主动脉瘤的比例较小(0.7 - 1.31%)。在本文中,我们报告了一例57岁男性患者,因腹痛伴发热入院。初步诊断显示主动脉分叉处破裂,该患者符合手术治疗条件。术中,我们遇到主动脉分叉处破裂的动脉瘤,此外还发现了感染特征(培养显示为金黄色葡萄球菌),这排除了使用涤纶人工血管的可能性。由于患者血流动力学状态稳定,我们决定使用从单一下肢采集的深静脉进行“原位”主-髂动脉重建。这种手术很少在急诊情况下进行,然而,潜在益处可能超过技术上更具挑战性的手术风险。术后过程中,针对金黄色葡萄球菌的抗菌治疗在术后持续了12周。在超过5年的随访中,长期通畅良好,没有移植血管再感染或退化的迹象。

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