Amorim Pedro, Sousa Gonçalo, Vieira João, C E Sousa Lourenço, Ribeiro Karla, Sobrinho Gonçalo, Vieira Teresa, Meireles Nuno, Albino Pereira
Serviço de Angiologia e Cirurgia Vascular II do Hospital Pulido Valente, Centro Hospitalar Lisboa Norte, Lisboa, Portugal.
Rev Port Cir Cardiotorac Vasc. 2014 Jan-Mar;21(1):65-8.
Infectious aneurysms are about 1-3% of all aneurysms of the infrarenal aorta. Its treatment is challenging and the best strategy is far from consensual. The authors report a case of a HIV + patient with multiple other co-morbidities, which was seen in the emergency department with fever and left back pain. These symptoms would prove to be in relation to a ruptured infectious aneurysm of the abdominal aorta. Facing this situation it was decided to select an endovascular technique with implantation of an aorto uni - iliac stent graft with a right-left femoro-femoral cross-over using a 8 mm PTFE graft and exclusion of the left common iliac . The patient didn't have any complication from the situation or the procedure, but died 18 months postoperatively because of a pneumonia caused by Pneumocystis jiroveci. Although it is not the ideal solution for the treatment of infectious elective aneurysms, we believe that endovascular treatment seems to be a viable option and should be taken into account in a subgroup of patients that for their co-morbidities are not good candidates for conventional surgery and for those in rupture, either as a bridge or as a final solution.
感染性动脉瘤约占肾下腹主动脉瘤的1% - 3%。其治疗具有挑战性，最佳策略远未达成共识。作者报告了一例合并多种其他疾病的HIV阳性患者，该患者因发热和左背痛在急诊科就诊。这些症状被证实与腹主动脉感染性动脉瘤破裂有关。面对这种情况，决定选择一种血管内技术，植入带8毫米聚四氟乙烯（PTFE）移植物的主动脉单髂动脉支架移植物，并通过左右股-股交叉搭桥，同时排除左髂总动脉。患者在病情或手术过程中未出现任何并发症，但术后18个月因耶氏肺孢子菌肺炎死亡。尽管这并非治疗感染性择期动脉瘤的理想解决方案，但我们认为血管内治疗似乎是一种可行的选择，对于因合并症而不适合传统手术的患者亚组以及破裂患者，无论是作为桥梁还是最终解决方案，都应予以考虑。
