Andersson Sebastian, Monsen Christina, Acosta Stefan
Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden; Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden.
Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden; Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden.
Ann Vasc Surg. 2018 Apr;48:104-110. doi: 10.1016/j.avsg.2017.10.018. Epub 2017 Dec 5.
The aim of this study was to investigate graft preservation, major bleeding, and reinfection rate using negative pressure wound therapy (NPWT) for perivascular surgical site infections (SSIs) in the groin after vascular surgery and factors associated with failure of treatment.
Retrospective data were collected during 2004-2015. Failure of wound treatment was defined as a wound not healed within 4 months, visible graft material or native artery after 1 month, bleeding from the wound leading to discontinuation of treatment, or death or amputation due to the groin infection.
The median age of the 161 patients was 71 years; 63% were men. The rate of graft preservation rate was 81%; 64% for synthetic grafts. Major bleeding during NPWT occurred in 7.1% and local reinfection in 6.4%. Synthetic graft infection (odds ratio [OR] = 6.1, 95% confidence interval [CI] = 2.6-14.4) and bleeding/pseudoaneurysm as presenting symptom (OR = 2.9, 95% CI = 1.0-8.2) were independently associated with increased failure rate of treatment.
NPWT is a good option for perivascular SSI in the groin after vascular surgery. Patients with a synthetic graft infection and/or presenting with pseudoaneurysm or bleeding may be considered for an adjunctive or alternative treatment option.
本研究旨在探讨负压伤口治疗(NPWT)用于血管手术后腹股沟血管周围手术部位感染(SSI)的移植物保存、大出血及再感染率,以及与治疗失败相关的因素。
收集2004年至2015年的回顾性数据。伤口治疗失败定义为伤口在4个月内未愈合、1个月后可见移植物材料或天然动脉、伤口出血导致治疗中断,或因腹股沟感染导致死亡或截肢。
161例患者的中位年龄为71岁;63%为男性。移植物保存率为81%;合成移植物为64%。NPWT期间大出血发生率为7.1%,局部再感染率为6.4%。合成移植物感染(比值比[OR]=6.1,95%置信区间[CI]=2.6-14.4)以及以出血/假性动脉瘤为表现症状(OR=2.9,95%CI=1.0-8.2)与治疗失败率增加独立相关。
NPWT是血管手术后腹股沟血管周围SSI的一个良好选择。对于合成移植物感染和/或表现为假性动脉瘤或出血的患者,可考虑采用辅助或替代治疗方案。