Moulakakis Konstantinos G, Sfyroeras George S, Mylonas Spyridon N, Mantas George, Papapetrou Anastasios, Antonopoulos Constantine N, Kakisis John D, Liapis Christos D
Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
J Endovasc Ther. 2014 Jun;21(3):448-55. doi: 10.1583/13-4575MR.1.
To review the published outcomes of aortic endograft infection treated with preservation of the stent-graft.
An extensive electronic health database search was undertaken to identify all articles published up to May 2013 that reported endograft infection after endovascular aneurysm repair (EVAR) in which treatment included preservation of the stent-graft. The search found 17 articles with 29 patients (27 men; mean age 73.1±7.6 years) fulfilling the inclusion criteria.
In 2 (7%) cases, the endograft infection was diagnosed within 30 days of the initial procedure; 4 (14%) were identified within 3 months and the remaining 23 (79%) within 12 months. Staphylococcus species, Streptococcus species, and Escherichia coli were the most common isolated microorganisms. Seven (24%) had a secondary aortoenteric fistula after EVAR. Twelve (41%) patients received only antibiotic therapy, while the remaining had an additional procedure (drainage, surgical debridement, sac irrigation, and/or omentoplasty). The in-hospital mortality was 21% (n=6). During a mean follow-up of 11.4±3.1 months, 7 more patients died (overall mortality 45%). None of the 7 patients with fistula survived. Half (50%) of the 12 patients who received only antibiotic therapy died, while 7 (41%) of the 17 patients who underwent an additional procedure died during follow-up.
Among patients treated for endograft infection without explantation, those with aortoenteric fistula had the worst outcome. There is evidence for lower mortality in patients who underwent an additional procedure, such as drainage, surgical debridement, and sac irrigation. Larger studies are needed to examine the efficacy of this approach compared to surgical conversion with endograft excision and in situ reconstruction or extra-anatomical bypass.
回顾保留支架型人工血管治疗主动脉内支架型人工血管感染的已发表结果。
进行广泛的电子健康数据库检索，以识别截至2013年5月发表的所有报告血管内动脉瘤修复术（EVAR）后支架型人工血管感染的文章，其中治疗包括保留支架型人工血管。检索发现17篇文章，有29例患者（27例男性；平均年龄73.1±7.6岁）符合纳入标准。
2例（7%）患者在初次手术后30天内被诊断为支架型人工血管感染；4例（14%）在3个月内被确诊，其余23例（79%）在12个月内被确诊。葡萄球菌属、链球菌属和大肠杆菌是最常见的分离微生物。7例（24%）患者在EVAR后发生继发性主动脉肠瘘。12例（41%）患者仅接受抗生素治疗，其余患者还接受了其他手术（引流、手术清创、囊腔冲洗和/或网膜成形术）。住院死亡率为21%（n = 6）。在平均11.4±3.1个月的随访期间，又有7例患者死亡（总死亡率45%）。7例有瘘管的患者均未存活。仅接受抗生素治疗的12例患者中有一半（50%）死亡，而接受其他手术的17例患者中有7例（41%）在随访期间死亡。
在未取出支架型人工血管治疗感染的患者中，有主动脉肠瘘的患者预后最差。有证据表明，接受引流、手术清创和囊腔冲洗等其他手术的患者死亡率较低。与采用切除支架型人工血管并原位重建或解剖外旁路的手术转换相比，需要更大规模的研究来检验这种方法的疗效。
