Department of Vascular Surgery, The First Hospital of Changsha, Changsha, Hunan, People's Republic of China.
Division of Vascular Surgery and Endovascular Therapy, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
Ann Vasc Surg. 2021 Jan;70:449-458. doi: 10.1016/j.avsg.2020.06.058. Epub 2020 Jul 4.
The aim of this study is to assess the incidence, clinical manifestations, management, and prognosis of graft infection after bypass surgery with prosthetic conduit for infectious femoral artery pseudoaneurysms (IFAPs) in patients with a history of intravenous drug use (IVDU).
A single-center retrospective chart review of IVDU presenting with graft infections after previously being treated with extra-anatomic prosthetic conduit bypass surgery for IFAPs between 2009 and 2019 was performed. Relevant clinical data and patient demographics were collected and analyzed. All patients underwent procedures consisting of graft removal with analysis of operative details and complications.
Of all 122 patients who underwent IFAP resection with extra-anatomic prosthetic bypass, the incidence of graft infection was 38.5% (47 patients, 48 grafts) with an average age of 35.7 ± 7.3 years. The average interval between bypass surgery and infectious symptoms was 9.2 ± 2.5 months and average time from bypass to graft removal was 13.6 ± 3.4 months. The most common presentation was repeated or unhealable chronic ulcers with sinus formation or purulence either within the bypass area or along the graft conduit route (43, 89.6%). Occlusion of the infected bypass graft occurred in nearly all cases (46, 95.8%). Severe hemorrhage occurred in only 1 case (2.1%). After graft removal, the stumps were ligated in the majority of patients (33, 68.8%) with 15 patients (31.2%) not amenable to ligation due to a difficult dissection. The average time of operation was 35.4 ± 8.7 min with an average blood loss of 35.8 ± 6.7 mL. There were no significant complications such as infection reoccurrence, severe limb ischemia, amputation, or death observed postoperatively.
Patients who receive bypass surgery with prosthetic conduit for IFAPs carry a high incidence of graft infection and subsequent occlusion. However, the presenting symptoms are generally mild, and the incidence of fatal complications is rare. This study suggests that a safe treatment option consists of direct graft removal without reconstruction. Additionally, the procedure proved to be relatively convenient and straightforward, which provides further support toward the strategy of treating IFAPs in IVDUs with pseudoaneurysm resection and prosthetic conduit bypass surgery.
本研究旨在评估有静脉药物使用史（IVDU）的患者因感染性股动脉假性动脉瘤（IFAP）而行人造血管旁路手术后移植物感染的发生率、临床表现、处理方法和预后。
对 2009 年至 2019 年期间，因 IFAP 行解剖外人造血管旁路手术后出现移植物感染的 IVDU 患者进行了单中心回顾性图表回顾。收集并分析了相关的临床数据和患者人口统计学资料。所有患者均行移植物切除手术，分析手术细节和并发症。
在 122 例行 IFAP 切除和解剖外人造血管旁路手术的患者中，移植物感染的发生率为 38.5%（47 例，48 个移植物），平均年龄为 35.7±7.3 岁。旁路手术后至感染症状出现的平均时间为 9.2±2.5 个月，自旁路至移植物切除的平均时间为 13.6±3.4 个月。最常见的表现为反复或无法治愈的慢性溃疡，伴有窦道形成或脓肿，位于旁路区域或移植物导管路径内（43 例，89.6%）。几乎所有感染旁路移植物都发生了闭塞（46 例，95.8%）。仅 1 例（2.1%）发生严重出血。移植物切除后，大部分患者（33 例，68.8%）结扎残端，15 例（31.2%）因难以解剖而无法结扎。手术平均时间为 35.4±8.7 分钟，平均失血量为 35.8±6.7 毫升。术后未观察到感染复发、严重肢体缺血、截肢或死亡等严重并发症。
接受 IFAP 人造血管旁路手术的患者移植物感染和随后闭塞的发生率较高。然而，临床表现通常较轻，致命并发症的发生率较低。本研究表明，安全的治疗选择是直接切除移植物而不重建。此外，该手术相对方便和直接，为在有静脉药物使用史的患者中采用假性动脉瘤切除和人造血管旁路手术治疗 IFAP 提供了进一步支持。
