腔内治疗真菌性主动脉瘤：一项欧洲多中心研究。
Endovascular treatment of mycotic aortic aneurysms: a European multicenter study.
机构信息
From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy's & St. Thomas' Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George's Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom (K.I., M.D.); Regional Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (M.P.J., U.J.); Department of Cardiovascular Sciences and the NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, United Kingdom (M.B.); Clinic for Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland (Z.R., D.M.); Department of Vascular Surgery, University of Cologne, Cologne, Germany (J. Brunkwall, M.G.); Department for Vascular Medicine, University Heart Center, University Hospital Eppendorf Hamburg, Hamburg, Germany (T.K.); Division of Vascular Surgery, University of Nice-Sophia Antipolis, Nice, France (E.J.-B.); Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands (F.M., P.B.); Department of Vascular Surgery, Attikon University Hospital, Athens, Greece (C.D.L., K.G.M.); Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden (M.L., K.R.); and Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden (T.L., A.P.).
出版信息
Circulation. 2014 Dec 9;130(24):2136-42. doi: 10.1161/CIRCULATIONAHA.114.009481. Epub 2014 Nov 5.
BACKGROUND
Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infection-related complications and long-term survival.
METHODS AND RESULTS
All EVAR treated MAAs, between 1999 and 2013 at 16 European centers, were retrospectively reviewed. One hundred twenty-three patients with 130 MAAs were identified. Mean age was 69 years (range 39-86), 87 (71%) were men, 58 (47%) had immunodeficiency, and 47 (38%) presented with rupture. Anatomic locations were ascending/arch (n=4), descending (n=34), paravisceral (n=15), infrarenal aorta (n=63), and multiple (n=7). Treatments were thoracic EVAR (n=43), fenestrated/branched EVAR (n=9), and infrarenal EVAR (n=71). Antibiotic was administered for mean 30 weeks. Mean follow-up was 35 months (range 1 week to 149 months). Six patients (5%) were converted to open repair during follow-up. Survival was 91% (95% confidence interval, 86% to 96%), 75% (67% to 83%), 55% (44% to 66%), and 41% (28% to 54%) after 1, 12, 60, and 120 months, respectively. Infection-related death occurred in 23 patients (19%), 9 after discontinuation of antibiotic treatment. A Cox regression analysis demonstrated non-Salmonella-positive culture as predictors for late infection-related death.
CONCLUSIONS
Endovascular treatment of MAA is feasible and for most patients a durable treatment option. Late infections do occur, are often lethal, and warrant long-term antibiotic treatment and follow-up. Patients with non-Salmonella-positive blood cultures were more likely to die from late infection.
背景
真菌性主动脉瘤（MAA）是一种罕见且危及生命的疾病。本项欧洲多中心合作旨在通过评估晚期感染相关并发症和长期生存率，研究 MAA 的血管内主动脉修复（EVAR）的耐久性。
方法和结果
回顾性分析了 1999 年至 2013 年在 16 个欧洲中心接受 EVAR 治疗的所有 MAA。共确定了 123 例 130 例 MAA 患者。平均年龄为 69 岁（范围 39-86 岁），87 例（71%）为男性，58 例（47%）存在免疫缺陷，47 例（38%）表现为破裂。解剖部位包括升主动脉/主动脉弓（n=4）、降主动脉（n=34）、内脏旁（n=15）、肾下主动脉（n=63）和多处（n=7）。治疗方法包括胸主动脉 EVAR（n=43）、开窗/分支 EVAR（n=9）和肾下 EVAR（n=71）。抗生素的平均使用时间为 30 周。平均随访时间为 35 个月（范围 1 周到 149 个月）。6 例（5%）患者在随访期间转为开放修复。1、12、60 和 120 个月时的生存率分别为 91%（95%置信区间，86%至 96%）、75%（67%至 83%）、55%（44%至 66%）和 41%（28%至 54%）。23 例（19%）患者发生感染相关死亡，9 例在抗生素治疗停止后死亡。Cox 回归分析显示，非沙门氏菌阳性培养是导致晚期感染相关死亡的预测因素。
结论
MAA 的血管内治疗是可行的，对于大多数患者来说是一种持久的治疗选择。晚期感染确实会发生，且常常是致命的，需要长期的抗生素治疗和随访。血培养非沙门氏菌阳性的患者更有可能因晚期感染而死亡。
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