Pallister Zachary S, Chung Jayer
Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Vasc Specialist Int. 2021 Mar 31;37(1):4-13. doi: 10.5758/vsi.210002.
While rare, abdominal aortic infections remain one of the most technically and emotionally challenging cases that a vascular surgeon may face. Secondary infections of either endovascular, or open aortic reconstructions range from 0.2% to 8%. Primary aortic infections are much more rare. Diagnosis can be elusive, depending upon the virulence of the causative microbes, and extent of the infection. Patients are often brittle, with immunocompromise and malnutrition prevalent in this patient population. The gold standard diagnostic test remains a computed tomographic angiogram. The mainstay of management requires vascular control, and wide debridement of all infected materials and revascularization. Multiple methods exist to reconstruct the vascular supply. The neo-aortoiliac system (NAIS) is attractive as it utilizes the patient's own femoral veins to reconstruct the vascular supply after the infection has been extirpated. The procedure is demanding upon the patient and surgeons alike. Also, the rarity of aortic infections limit experiences the literature to centers of excellence. However, the NAIS resists infection well, leaving the patient without any remaining foreign bodies. No further costs for conduit are incurred. Moreover, multiple experiences show excellent durability. While comparative effectiveness literature remains sparse, we believe the NAIS to be the optimal method of revascularization for select patients. In this article, we will review the use of NAIS for primary and secondary aortic infections. In particular, we will emphasize procedural details to help enable the reader to apply this procedure most effectively to their own patients.
腹主动脉感染虽然罕见，但仍然是血管外科医生可能面临的技术和情感上最具挑战性的病例之一。血管腔内修复术或开放性主动脉重建术后的继发感染率为0.2%至8%。原发性主动脉感染则更为罕见。诊断可能很困难，这取决于致病微生物的毒力和感染程度。这类患者通常身体状况较差，免疫功能低下和营养不良很常见。金标准诊断测试仍然是计算机断层血管造影。治疗的主要方法需要控制血管、广泛清除所有感染物质并进行血管重建。存在多种重建血管供应的方法。新主动脉髂动脉系统（NAIS）很有吸引力，因为它在感染被清除后利用患者自身的股静脉来重建血管供应。该手术对患者和外科医生都要求很高。此外，主动脉感染的罕见性使得文献报道多限于一些卓越中心的经验。然而，NAIS抗感染能力良好，患者体内不会残留任何异物。无需额外的管道费用。而且，多项经验表明其耐久性极佳。虽然比较有效性的文献仍然很少，但我们认为NAIS是某些特定患者血管重建的最佳方法。在本文中，我们将回顾NAIS在原发性和继发性主动脉感染中的应用。特别是，我们将强调手术细节，以帮助读者最有效地将该手术应用于自己的患者。
