von Aspern Konstantin, Etz Christian D, Mohr Friedrich W, Battellini Roberto R
Department of Cardiac Surgery, University Heart Center Leipzig, Saxony, Germany.
Department of Cardiovascular Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Aorta (Stamford). 2015 Aug 1;3(4):140-4. doi: 10.12945/j.aorta.2015.14.063. eCollection 2015 Aug.
Prosthetic graft infections with mediastinitis following aortic surgery are rare, yet represent grave complications yielding high morbidity and mortality. We present the case of a 57-year-old female patient with past history of emergent surgery for iatrogenic Type A dissection treated by supracoronary ascending aortic replacement. Four months after the initial surgery, a sternal fistula had formed and due to severe bleeding emergent reoperation was required. Imaging and pathology on admission revealed an infected pseudoaneurysm at the distal aortic prosthesis and mediastinitis with methicillin-resistant Staphylococcus aureus. Rescue surgery was performed by means of a two-stage approach, with extensive debridement, graft replacement and continuous antiseptic lavage in a first step and an omental wrapping of the new prosthesis in a second stage 24 hours later. During 10 years of follow-up, no recurrent infection occurred. The operative approach and general considerations for management of infected pseudoaneurysms are discussed.
主动脉手术后发生人工血管感染合并纵隔炎的情况较为罕见，但却是严重的并发症，具有较高的发病率和死亡率。我们报告一例57岁女性患者，既往有因医源性A型夹层行急诊手术史，接受了冠状动脉上方升主动脉置换术。初次手术后四个月，形成了胸骨瘘，因严重出血需要急诊再次手术。入院时的影像学和病理学检查显示，主动脉远端人工血管处存在感染性假性动脉瘤，并伴有耐甲氧西林金黄色葡萄球菌引起的纵隔炎。采用两阶段手术方法进行挽救手术，第一步进行广泛清创、人工血管置换和持续抗菌灌洗，24小时后的第二步对新的人工血管进行网膜包裹。在10年的随访期间，未发生复发性感染。本文讨论了感染性假性动脉瘤的手术方法及一般处理原则。
