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一例罕见的主动脉-双股动脉移植感染病例报告及其治疗

A case report of a unique aorto-bifemoral graft infection and its treatment.

作者信息

Uslu Hatim Yahya, Kurt Halil

机构信息

Department of General Surgery, TOBB ETU University, Ankara, TURKIYE.

Department of Internal Medicine (Infectious Diseases), TOBB ETU University, Ankara, TURKIYE.

出版信息

J Surg Case Rep. 2020 Nov 10;2020(11):rjaa382. doi: 10.1093/jscr/rjaa382. eCollection 2020 Nov.

Abstract

In this study, we report a unique case of aorto-bifemoral graft infection, which developed in a 47-year-old male patient after endovascular aortic aneurysmal repair (EVAR) and extra anatomic axillo-femoral bypass. The patient had previously been treated by EVAR for an infrarenal abdominal aortic aneurysm. Earlier, the EVAR was blocked by a thrombosis and treated with an extra-anatomic axillo femoral bypass, which then became occluded. The patient was then treated with an aorto-bifemoral bypass using a Dacron Y graft. A few months later, he was referred to our cardiovascular center with high body temperature, weight loss, inability to stand and walk, and very serious sepsis. A computed abdominal tomography scan revealed that a part of the graft proximal to the bifurcation had totally eroded into the proximal jejunum. We treated this patient with multiple surgeries, antibiotic administrations and hypochlorous acid irrigation without graft excision, which carries a high morbidity and mortality risks.

摘要

在本研究中,我们报告了一例独特的主动脉-双股动脉移植物感染病例,该病例发生在一名47岁男性患者身上,该患者在接受血管腔内主动脉瘤修复术(EVAR)和解剖外腋-股动脉旁路移植术后出现感染。该患者此前曾因肾下腹主动脉瘤接受EVAR治疗。此前,EVAR因血栓形成而堵塞,并接受了解剖外腋-股动脉旁路移植术治疗,但随后该旁路移植术也发生了闭塞。随后,该患者接受了使用涤纶Y型移植物的主动脉-双股动脉旁路移植术。几个月后,他因高热、体重减轻、无法站立和行走以及非常严重的脓毒症被转诊至我们的心血管中心。腹部计算机断层扫描显示,移植物分叉近端的一部分已完全侵蚀至空肠近端。我们对该患者进行了多次手术、抗生素治疗和次氯酸冲洗,未切除移植物,因为切除移植物会带来较高的发病率和死亡率风险。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d6a8/7655013/6962ebf7a76b/rjaa382f1.jpg

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