Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria.
Department of Vascular Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria.
J Vasc Surg. 2021 Jun;73(6):2123-2131.e2. doi: 10.1016/j.jvs.2020.11.028. Epub 2020 Dec 2.
Infection of prosthetic aortic grafts represents a serious complication with high morbidity and mortality. Replacement with autologous material is recommended; however, in its absence, biological material should be favored. In the present retrospective cohort study, we evaluated the short- and midterm results with the use of commercially available prefabricated bovine pericardium grafts (BPGs) used for the management of aortic graft infection or aortic reconstructive surgery in the presence of systemic infection.
We performed a retrospective analysis of patients in whom BPGs had been used for aortic reconstruction at two vascular centers. Prefabricated vascular pericardium grafts were preferred over other biological reconstruction techniques for selected cases. Comorbidities, procedure-related details, perioperative morbidity, clinical outcomes, and mortality were analyzed.
From 2014 to 2019, 21 patients had received BPGs at two Austrian vascular centers. Their median age was 63 years (interquartile range [IQR], 55-71 years), the patients were predominantly male (76%), and the median body mass index was 25.3 kg/m (IQR, 21.7-27.3 kg/m). The major comorbidities included arterial hypertension, peripheral artery disease, smoking, and chronic pulmonary disease. The indications for surgery were vascular graft or endograft infection in 62% and aortic reconstruction in the presence of systemic infection in 38%. Three patients (14%) had aortoenteric fistulas. Surgery was technically successful in all cases. The median follow-up was 21.6 months (IQR, 6.0-34.6 months). The 30-day mortality was 9.5%. The 1- and 2-year overall survival was 84% and 75%, respectively. Of the 21 patients, 89% had remained free of recurrent infection. One of the two reinfections had resolved after treatment of the underlying focus. At 2 years, the primary and assisted primary patency rates were 86% and 94%, respectively. No limbs were lost during follow-up.
Prefabricated BPGs represent a promising alternative for the management of aortic graft infections and aortoiliac reconstruction in the presence of systemic infection.
人造血管移植物感染是一种严重的并发症，具有较高的发病率和死亡率。建议使用自体材料进行替换；然而，在缺乏自体材料的情况下，应优先选择生物材料。在本回顾性队列研究中，我们评估了使用市售预制牛心包移植物（BPG）治疗全身感染时主动脉移植物感染或主动脉重建手术中主动脉移植物感染或主动脉重建手术的短期和中期结果。
我们对两家血管中心使用 BPG 进行主动脉重建的患者进行了回顾性分析。对于选定的病例，优先使用预制血管心包移植物进行其他生物重建技术。分析了合并症、手术相关细节、围手术期发病率、临床结局和死亡率。
2014 年至 2019 年，两家奥地利血管中心共 21 例患者接受 BPG 治疗。患者中位年龄为 63 岁（四分位距[IQR]：55-71 岁），患者主要为男性（76%），中位体重指数为 25.3kg/m（IQR：21.7-27.3kg/m）。主要合并症包括高血压、外周动脉疾病、吸烟和慢性肺部疾病。手术指征包括血管移植物或血管内移植物感染 62%，全身感染合并主动脉重建 38%。3 例（14%）患者发生肠瘘。所有病例均成功完成手术。中位随访时间为 21.6 个月（IQR：6.0-34.6 个月）。30 天死亡率为 9.5%。1 年和 2 年总生存率分别为 84%和 75%。21 例患者中，89%无复发性感染。2 例再感染中有 1 例经治疗潜在病灶后已痊愈。2 年时，原发性通畅率和辅助原发性通畅率分别为 86%和 94%。随访期间无肢体丧失。
预制 BPG 是治疗全身感染时主动脉移植物感染和腹主动脉重建的一种有前途的选择。
