Chen Xiyang, Yuan Ding, Zhao Jichun, Huang Bin, Yang Yi
Department of Vascular Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Medicine (Baltimore). 2019 Feb;98(6):e14330. doi: 10.1097/MD.0000000000014330.
Treatment of infection aortic pseudoaneurysm (PSA) is a great challenge to surgeons for 3 reasons: high mortality for rupture or threatened rupture; potential risk for infection of prosthetic material which probably bring a devastating result for patients; and long-term antibiotic therapy requirement. Endovascular repair is an alternative to open surgery for a less invasive, which is a trouble procedure for aortic PSA with complex aortic anatomy. The purpose of this article is to report the novel hybrid repair of an infection aortic PSA and antibiotics therapy.
A 61-year-old man with complaints of repeated abdominal pain and fever for 3 months was admitted. He had a fever of 39.0°C and normal blood pressure. The blood leukocyte count was 14.9 × 10/L, C-reactive protein was 132 mg/L. There was no evidence for urinary tract infection. The small effusion was identified in bilateral thoracic cavity and pelvis cavity, and the severe lung function impairment was detected. Klebsiella pneumoniae was identified in blood cultures. Computer tomographic (CT) angiography showed a 6 cm × 6 cm aortic PSA involving bilateral renal arteries and a subhepatic inflammatory mass (identified by percutaneous puncture).
According to the symptoms, CT and lab test, the main diagnosis for this patient were: infective aortic PSA involving bilateral renal arteries, and Bacteremia with K pneumoniae.
A hybrid procedure combined open surgical and endovascular was performed for managing the paravisceral infection aortic PSA in a 61-year-old man with high risk. To decrease the risk of graft infection, autologous saphenous vein graft was adopted, and long-term antibiotic therapy was used. At 2 years follow-up, the patient was in good clinical condition with continued antibiotic therapy.
Hybrid procedure is an alternative approach according to high risk patients with complex anatomy for open repair of infection aortic PSA. The postoperative long-time continued antibiotic therapy must be emphasized for infection PSA.
感染性主动脉假性动脉瘤（PSA）的治疗对外科医生而言是一项巨大挑战，原因有三：破裂或有破裂风险时死亡率高；使用人工材料存在感染风险，这可能给患者带来灾难性后果；需要长期抗生素治疗。血管腔内修复术是开放手术的一种替代方案，具有侵入性较小的特点，但对于主动脉解剖结构复杂的主动脉PSA而言，这是一个棘手的手术。本文旨在报告一例感染性主动脉PSA的新型杂交修复术及抗生素治疗情况。
一名61岁男性因反复腹痛和发热3个月入院。他体温达39.0°C，血压正常。血白细胞计数为14.9×10⁹/L，C反应蛋白为132mg/L。无尿路感染证据。双侧胸腔和盆腔发现少量积液，且检测到严重肺功能损害。血培养鉴定出肺炎克雷伯菌。计算机断层扫描（CT）血管造影显示一个6cm×6cm的主动脉PSA累及双侧肾动脉以及一个肝下炎性肿块（经皮穿刺确定）。
根据症状、CT和实验室检查，该患者的主要诊断为：累及双侧肾动脉的感染性主动脉PSA，以及肺炎克雷伯菌菌血症。
对一名高风险的61岁男性，采用开放手术与血管腔内修复相结合的杂交手术来处理累及内脏旁的感染性主动脉PSA。为降低移植物感染风险，采用了自体大隐静脉移植物，并使用了长期抗生素治疗。在2年的随访中，患者在持续抗生素治疗下临床状况良好。
对于解剖结构复杂、开放修复手术风险高的感染性主动脉PSA患者，杂交手术是一种替代方法。对于感染性PSA，术后必须强调长期持续抗生素治疗。
