Shiraev Timothy, Barrett Sean, Heywood Sean, Mirza Wasif, Hunter-Dickson Mitchell, Bradshaw Camilla, Hardman David, Neilson Wendell, Bradshaw Stephen
Department of Vascular Surgery, Canberra Hospital, Garran, ACT, Australia.
Department of Vascular Surgery, Canberra Hospital, Garran, ACT, Australia.
Ann Vasc Surg. 2019 Aug;59:73-83. doi: 10.1016/j.avsg.2019.01.027. Epub 2019 Apr 19.
Infection complicates 1% of aortic grafts, and although uncommon, the associated morbidity and mortality are significant. We sought to determine risk factors for aortic graft infection (AGI), the long-term outcomes in patients managed both nonoperatively and via explantation.
This observational study reviewed sequential aortic grafts (thoracic or abdominal) inserted via open or endovascular means between 2000 and 2017. We used Cox proportional hazards regression analyses to compare risk factors between groups who did and did not acquire an AGI and recorded method of management, morbidity, mortality, and duration to adverse event.
There were 883 aortic repairs, 49% were endovascular. 17.2% were for ruptured aneurysms, 1.1% for symptomatic aneurysms, 1.4% for type B dissections, and 0.5% for occlusive disease. Twelve patients presented with AGI, of which ten had their index procedure performed at our institution (AGI incidence of 1.1%). There was no difference in rates of AGI between open and endovascular repairs (0.9 vs. 1.4%, P = 0.24). AGI was significantly associated with emergency aortic repair (HR 3.63, 95% CI 1.13-11.57, P = 0.03), septic process requiring in-patient management during follow-up (HR 5.44, 95% CI 1.21-24.26, P = 0.02), and suprarenal clamping during open repair (HR 5.21, 95% CI 1.00-26.99, P = 0.05). Four patients were managed with explantation and revascularization (3 extra-anatomical bypasses) and remained well at a median follow-up of 46 months. Of the 8 patients managed nonoperatively, 4 died at an average of 13.5 days after representation, and the other 4 remained well on oral antibiotics at a median follow-up of 26.5 months. No patient suffered limb loss, and there was no change in the rate of infection over the period.
Incidence of AGI remains low but is associated with significant mortality. Patients with aortic grafts in situ require aggressive treatment of septic foci to prevent graft infection.
感染使1%的主动脉移植物出现并发症，虽然不常见，但相关的发病率和死亡率却很高。我们试图确定主动脉移植物感染（AGI）的危险因素，以及非手术治疗和移植手术治疗患者的长期预后。
这项观察性研究回顾了2000年至2017年间通过开放手术或血管腔内技术植入的连续性主动脉移植物（胸段或腹段）。我们使用Cox比例风险回归分析比较发生和未发生AGI的两组患者的危险因素，并记录治疗方法、发病率、死亡率和不良事件发生时间。
共进行了883例主动脉修复手术，其中49%为血管腔内修复。17.2%用于治疗破裂性动脉瘤，1.1%用于治疗有症状的动脉瘤，1.4%用于治疗B型夹层动脉瘤，0.5%用于治疗闭塞性疾病。12例患者发生AGI，其中10例在我们机构进行了初次手术（AGI发生率为1.1%）。开放手术和血管腔内修复的AGI发生率无差异（0.9%对1.4%，P = 0.24）。AGI与急诊主动脉修复显著相关（风险比[HR] 3.63，95%置信区间[CI] 1.13 - 11.57，P = 0.03）、随访期间需要住院治疗的脓毒症（HR 5.44，95% CI 1.21 - 24.26，P = 0.02）以及开放手术期间的肾上腺上动脉阻断（HR 5.21，95% CI 1.00 - 26.99，P = 0.05）。4例患者接受了移植手术和血管重建（3例采用解剖外旁路），中位随访46个月时情况良好。在8例非手术治疗的患者中，4例在就诊后平均13.5天死亡，另外4例在中位随访26.5个月时口服抗生素情况良好。无患者肢体丧失，在此期间感染率无变化。
AGI的发生率仍然较低，但与显著的死亡率相关。原位主动脉移植物患者需要积极治疗感染灶以预防移植物感染。
