Schellack J, Stewart M T, Smith R B, Perdue G D, Salam A
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Am Surg. 1988 Mar;54(3):137-41.
From 1980 to 1985 13 patients were identified with infected aortofemoral grafts. Potential predisposing factors identified included a history of multiple femoral arterial procedures (10 patients; 77%) as well as perioperative infections occurring at the time of a prior femoral operation (five patients; 38%). Patients presented with suppurative groin infections (11) or ruptured pseudoaneurysms (2). Two who had previously undergone bilateral amputations were managed by removal of their aortic grafts without revascularization. Eleven other patients were managed by excision of the entire prosthesis (6 aortic grafts), partial graft excision (five graft limbs) or local treatment alone (three graft limbs). Revascularization through uninfected tissue planes was performed on 14 limbs with salvage of 11 (limb salvage 79%); whereas three limbs not revascularized required major amputation (limb salvage 0%). Despite an aggressive surgical approach five patients (38%) required a major amputation and there were three deaths (23% mortality). Once the diagnosis of an infected graft is made, early graft excision and prompt revascularization are encouraged.
1980年至1985年间，确诊有13例患者发生了人工血管感染。确定的潜在易感因素包括多次股动脉手术史（10例患者；77%）以及既往股动脉手术时发生的围手术期感染（5例患者；38%）。患者表现为化脓性腹股沟感染（11例）或假性动脉瘤破裂（2例）。2例之前接受过双侧截肢手术的患者通过切除主动脉移植物进行处理，未进行血管重建。其他11例患者通过切除整个假体（6例主动脉移植物）、部分移植物切除（5例移植物肢体）或仅进行局部治疗（3例移植物肢体）来处理。通过未感染的组织平面进行血管重建的有14条肢体，其中11条得以挽救（肢体挽救率79%）；而3条未进行血管重建的肢体需要进行大截肢（肢体挽救率0%）。尽管采取了积极的手术方法，仍有5例患者（38%）需要进行大截肢，并有3例死亡（死亡率23%）。一旦确诊人工血管感染，应尽早切除移植物并迅速进行血管重建。
