Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden.
Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
Eur J Vasc Endovasc Surg. 2016 May;51(5):724-32. doi: 10.1016/j.ejvs.2016.01.011. Epub 2016 Mar 2.
OBJECTIVE/BACKGROUND: Vascular graft infection is a serious and challenging complication. In situations when neither traditional radical surgery nor conservative negative pressure wound therapy (VAC) alone, are considered feasible or safe, for example due to bleeding, adverse anatomy, or severe comorbidity, a novel hybrid procedure was developed. The EndoVAC technique consists of (i) relining of the infected reconstruction with a stent graft; (ii) surgical revision (without clamping the reconstruction); and (iii) VAC therapy, to permit granulation and secondary delayed healing, and long-term antibiotic treatment. The aim of the study is to report long-term follow up data of this new treatment modality.
From November 2007 to June 2015, 17 EndoVAC procedures were performed in 16 patients (eight men, aged 16-91 years): six infected carotid patches after carotid endarterectomy, three infected neck deviations, two infected femoro-popliteal bypasses, three infected patches after femoral thrombo-endarterectomy, and two infected vascular accesses. Surveillance was performed routinely every 3-6 months and included clinical examination, hematologic tests, duplex ultrasonography, and imaging techniques, including 18F-fluorodeoxyglucose positron emission tomography/computed tomography.
Primary technical success rate was 100%. Antibiotics were prescribed for a median of 3 months (range 1-20 months). The median duration of VAC treatment was 14 days (range 9-57 days). Complications included early, transient stroke (n = 1), temporary hypoglossal palsy (n = 1), and late, asymptomatic occluded bypasses (n = 2), stent graft thrombosis (n = 1), and moderate carotid stenosis (n = 1). After a median of 5 years (range 1-90 months) of follow up, all patients had healed graft infections with no recurrence was observed. Eight patients died as a result of severe comorbidities, unrelated to the infection or hybrid procedure, 1 month-7 years after treatment.
The EndoVAC technique is an alternative, less invasive, option for treatment of infected vascular reconstructions in selected cases, when neither traditional radical surgery, nor conservative simple negative pressure wound therapy are considered feasible or safe. The exact indications for this alternative hybrid treatment need to be established.
目的/背景：血管移植物感染是一种严重且具有挑战性的并发症。在传统的根治性手术或单纯的负压创面治疗（VAC）均不可行或不安全的情况下，例如由于出血、解剖结构不良或严重合并症，需要采用一种新的混合手术方法。EndoVAC 技术包括：（i）用支架移植物重新衬里感染的重建；（ii）手术修正（不夹闭重建）；和（iii）VAC 治疗，以促进肉芽组织形成和二期延迟愈合，并进行长期抗生素治疗。本研究的目的是报告这种新治疗方法的长期随访数据。
从 2007 年 11 月至 2015 年 6 月，对 16 名患者（8 名男性，年龄 16-91 岁）进行了 17 例 EndoVAC 手术：6 例颈动脉内膜切除术后感染的颈动脉补片、3 例颈部感染性偏斜、2 例感染性股腘旁路、3 例股动脉血栓内膜切除术后感染的补片和 2 例感染性血管通路。常规每 3-6 个月进行一次监测，包括临床检查、血液学检查、双功能超声检查和影像学检查，包括 18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描。
初次技术成功率为 100%。抗生素的使用中位数为 3 个月（范围 1-20 个月）。VAC 治疗的中位数时间为 14 天（范围 9-57 天）。并发症包括早期短暂性中风（n=1）、暂时性舌下神经麻痹（n=1）和晚期无症状闭塞旁路（n=2）、支架移植物血栓形成（n=1）和中度颈动脉狭窄（n=1）。中位随访时间为 5 年（范围 1-90 个月），所有患者均治愈了感染的移植物，未观察到复发。8 例患者在治疗后 1 个月至 7 年内因严重合并症死亡，与感染或混合手术无关。
在传统的根治性手术或单纯的保守性负压创面治疗不可行或不安全的情况下，EndoVAC 技术是一种治疗感染性血管重建的替代、微创选择。需要确定这种替代混合治疗的确切适应证。
