200 例患者中使用冷冻保存的异体腹主动脉移植物替代感染性假体移植物的短期和中期结果。

Short and Mid Term Outcomes of Cryopreserved Abdominal Aortic Allografts Used as a Substitute for Infected Prosthetic Grafts in 200 Patients.

机构信息

Sorbonne Université, Department of Vascular Surgery, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, France.

出版信息

Eur J Vasc Endovasc Surg. 2021 Jul;62(1):89-97. doi: 10.1016/j.ejvs.2021.02.036. Epub 2021 Apr 12.

DOI:10.1016/j.ejvs.2021.02.036

PMID:33858752

Abstract

OBJECTIVE

To investigate the use of cryopreserved arterial allografts (CAA) as a substitute for infected infrarenal aortic prostheses, and its outcomes.

METHODS

A single centre retrospective study of consecutive patients receiving an abdominal aortic CAA after removal of an infected graft was conducted between January 1997 and December 2013. The primary outcome was the rate of allograft related revision surgery. Secondary outcomes were the 30 day mortality rate, survival, primary patency, limb salvage, and infection recurrence. Allograft ruptures secondary to infection and risk factors for allograft failure were also investigated.

RESULTS

Two hundred patients (mean age 64.2 ± 9.4 years) were included. In 56 (28%) cases, infection was related to an enteric fistula. The mean follow up duration was 4.1 years. The 30 day mortality rate was 11%. Early revision surgery was needed in 59 patients (29.5%). Among them, 15 (7.5%) were allograft related and led to the death of three patients (1.5%), corresponding to a 7.5% 30 day allograft related revision surgery rate. During the first six months, 17 (8.5%) patients experienced 21 events with complete or partial rupture (pseudo-aneurysm) of the allograft responsible for five (2.5%) deaths, corresponding to a re-infection rate of 8.5%. The multivariable analysis showed that diabetes and pseudo-aneurysm of the native aorta on presentation were predictive factors for short term allograft rupture. After six months, 25 (12.5%) patients experienced long term allograft complications (rupture, n = 2, 1%; pseudo-aneurysm, n = 6, 3%; aneurysm, n = 2, 1%; thrombosis, n = 11, 5.5%; stenosis, n = 4, 2%;) requiring revision surgery resulting in one death. The five year rates of survival, allograft related revision surgery, limb salvage, primary patency, and infection recurrence were 56%, 30%, 89%, 80%, and 12%, respectively.

CONCLUSION

CAAs provide acceptable results to treat aortic graft infection with few early graft related fatal complications. Long term allograft related complications are quite common but are associated with low mortality and amputation rates.

摘要

目的

探讨使用冷冻保存的动脉同种异体移植物（CAA）作为感染性腹主动脉假体的替代品及其结果。

方法

对 1997 年 1 月至 2013 年 12 月期间，因感染性移植物而接受腹部主动脉 CAA 治疗的连续患者进行了单中心回顾性研究。主要结果是同种异体移植物相关翻修手术的发生率。次要结果是 30 天死亡率、生存率、原发性通畅率、肢体存活率和感染复发率。还研究了同种异体移植物破裂继发于感染和同种异体移植物失败的危险因素。

结果

共纳入 200 例患者（平均年龄 64.2±9.4 岁）。56 例（28%）患者感染与肠瘘有关。平均随访时间为 4.1 年。30 天死亡率为 11%。59 例（29.5%）患者需要早期翻修手术。其中 15 例（7.5%）与同种异体移植物有关，导致 3 例患者死亡（1.5%），同种异体移植物相关 30 天翻修手术发生率为 7.5%。在最初的 6 个月内，17 例（8.5%）患者经历了 21 次同种异体移植物完全或部分破裂（假性动脉瘤）事件，其中 5 例（2.5%）死亡，再感染率为 8.5%。多变量分析显示，糖尿病和术前假性动脉瘤是短期同种异体移植物破裂的预测因素。6 个月后，25 例（12.5%）患者出现长期同种异体移植物并发症（破裂 2 例，1%；假性动脉瘤 6 例，3%；动脉瘤 2 例，1%；血栓形成 11 例，5.5%；狭窄 4 例，2%），需要翻修手术，导致 1 例死亡。5 年生存率、同种异体移植物相关翻修手术、肢体存活率、原发性通畅率和感染复发率分别为 56%、30%、89%、80%和 12%。