Moulakakis Konstantinos G, Alexiou Vangelis G, Sfyroeras George S, Kakisis John, Lazaris Andreas, Vasdekis Spyridon N, Brountzos Elias N, Geroulakos George
1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
3 Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
Vasa. 2017 Jan;46(1):5-9. doi: 10.1024/0301-1526/a000572. Epub 2016 Dec 7.
We conducted a systematic review regarding the efficacy and outcome of endovascular treatment of infected iliofemoral arterial pseudoaneurysms with covered stents. 35 cases were identified, including 5 own. 22 pseudoaneurysms were located in the femoral area and 13 in the iliac vessels. The most commonly reported complaints were pulsatile groin mass (40 %), sepsis (37.1 %), active bleeding (31.4 %), and groin infection with purulent discharge (17.1 %). S. aureus (65.7 %) and Streptococcus species (22.9 %) were the most common microbes isolated. Factors for the development of infected pseudoaneurysms were intravenous drug use (20 %), infection of anastomosis in bypass surgery (22.9 %), cancer (14.3 %), history of multiple hip operations (14.3 %), renal transplantation (2.9 %), and obesity (5.7 %). The most commonly used covered stents were Viabahn (22.9 %),Jostent (17.1 %), Fluency (14.3 %), and Wallgraft (14.3 %). In 15 cases, surgical debridement and/or drainage was also performed.The mean follow-up was 15.8 months. There were only 2 cases of stent graft thrombosis (5.7 %). 2 patients required an open vascular bypass procedure at a later stage. One death was attributed to procedure-related complications (2.9 %). The infection rate of the deployed stent graft in follow-up was 3.4 %. Endovascular exclusion of an infected pseudoaneurysm with primary stent grafting and drainage may be an option in high-risk patients. .
我们对使用覆膜支架进行血管腔内治疗感染性髂股动脉假性动脉瘤的疗效和结果进行了系统评价。共纳入35例患者，其中包括5例自身病例。22例假性动脉瘤位于股部区域，13例位于髂血管。最常见的主诉是搏动性腹股沟肿块（40%）、脓毒症（37.1%）、活动性出血（31.4%）和腹股沟感染伴脓性分泌物（17.1%）。分离出的最常见微生物是金黄色葡萄球菌（65.7%）和链球菌属（22.9%）。感染性假性动脉瘤形成的因素包括静脉药物使用（20%）、旁路手术吻合口感染（22.9%）、癌症（14.3%）、多次髋关节手术史（14.3%）、肾移植（2.9%）和肥胖（5.7%）。最常用的覆膜支架是Viabahn（22.9%）、Jostent（17.1%）、Fluency（14.3%）和Wallgraft（14.3%）。15例患者还进行了手术清创和/或引流。平均随访时间为15.8个月。仅2例发生支架移植物血栓形成（5.7%）。2例患者后期需要进行开放性血管旁路手术。1例死亡归因于手术相关并发症（2.9%）。随访中已植入的支架移植物感染率为3.4%。对于高危患者，采用初次支架植入和引流进行血管腔内排除感染性假性动脉瘤可能是一种选择。
