Department of Vascular Surgery, Tokyo Metropolitan Tama Medical Centre, Tokyo, Japan.
Department of Healthcare Quality Assessment, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Br J Surg. 2021 Apr 5;108(3):286-295. doi: 10.1093/bjs/znaa090.
Primary infected aneurysms of the abdominal aorta and iliac arteries are potentially life-threatening. However, because of the rarity of the disease, its pathogenesis and optimal treatment strategy remain poorly defined.
A nationwide retrospective cohort study investigated patients who underwent surgical treatment for a primary infected abdominal aortic and/or common iliac artery (CIA) aneurysm between 2011 and 2017 using a Japanese clinical registry. The study evaluated the relationships between preoperative factors and postoperative outcomes including 90-day and 3-year mortality, and persistent or recurrent aneurysm-related infection. Propensity score matching was used to compare survival between patients who underwent in situ prosthetic grafting and those who had endovascular aneurysm repair (EVAR).
Some 862 patients were included in the analysis. Preceding infection was identified in 30.2 per cent of the patients. The median duration of postoperative follow-up was 639 days. Cumulative overall survival rates at 30 days, 90 days, 1 year, 3 years and 5 years were 94.0, 89.7, 82.6, 74.9 and 68.5 per cent respectively. Age, preoperative shock and hypoalbuminaemia were independently associated with short-term and late mortality. Compared with open repair, EVAR was more closely associated with persistent or recurrent aneurysm-related infection (odds ratio 2.76, 95 per cent c.i. 1.67 to 4.58; P < 0.001). Propensity score-matched analyses demonstrated no significant differences between EVAR and in situ graft replacement in terms of 3-year all-cause and aorta-related mortality rates (P = 0.093 and P =0.472 respectively).
In patients undergoing surgical intervention for primary infected abdominal aortic and CIA aneursyms, postoperative survival rates were encouraging. Eradication of infection following EVAR appeared less likely than with open repair, but survival rates were similar in matched patients between EVAR and in situ graft replacement.
原发性腹主动脉和髂动脉感染性动脉瘤具有潜在的致命性。然而，由于这种疾病的罕见性，其发病机制和最佳治疗策略仍未得到明确界定。
本研究使用日本临床注册中心，对 2011 年至 2017 年间接受手术治疗的原发性感染性腹主动脉和/或髂总动脉瘤患者进行了一项全国性回顾性队列研究。研究评估了术前因素与术后结局（包括 90 天和 3 年死亡率以及持续性或复发性与动脉瘤相关的感染）之间的关系。采用倾向评分匹配比较原位假体移植与血管内动脉瘤修复术（EVAR）治疗患者的生存情况。
本研究共纳入 862 例患者。30.2%的患者有感染史。术后中位随访时间为 639 天。术后 30 天、90 天、1 年、3 年和 5 年的总生存率分别为 94.0%、89.7%、82.6%、74.9%和 68.5%。年龄、术前休克和低白蛋白血症与短期和晚期死亡率独立相关。与开放修复相比，EVAR 与持续性或复发性与动脉瘤相关的感染更密切相关（比值比 2.76，95%置信区间 1.67 至 4.58；P<0.001）。倾向评分匹配分析显示，EVAR 与原位移植在 3 年全因死亡率和主动脉相关死亡率方面无显著差异（P=0.093 和 P=0.472）。
在接受手术治疗的原发性感染性腹主动脉和髂总动脉瘤患者中，术后生存率令人鼓舞。与开放修复相比，EVAR 后感染的清除似乎不太可能，但 EVAR 与原位移植患者的匹配患者之间的生存率相似。
