Touma Joseph, Couture Thibault, Davaine Jean-Michel, de Boissieu Paul, Oubaya Nadia, Michel Cassandre, Cochennec Frédéric, Chiche Laurent, Desgranges Pascal
AP-HP, Henri Mondor University Hospital, Vascular surgery department, Creteil, France; Univ Paris Est Creteil, INSERM, IMRB, Creteil, France.
AP-HP, La Pitié-Salpêtrière University Hospital, Vascular Surgery Department, Paris, France.
Eur J Vasc Endovasc Surg. 2022 Mar;63(3):475-483. doi: 10.1016/j.ejvs.2021.10.041. Epub 2021 Dec 3.
Mycotic/infective native aortic aneurysms (INAA) are managed heterogeneously. In the context of disparate literature, this study aimed to assess the outcomes of INAA surgical management and provide comprehensive data in alignment with recent suggestions for reporting standards.
A retrospective review of patients presenting with INAA from September 2002 to March 2020 at two institutions was conducted. In hospital mortality, 90 day mortality, overall mortality, and infection related complications (IRCs) were the study endpoints. Overall survival and IRC free survival were estimated, and predictors of mortality tested using uni- and multivariable analyses.
Seventy patients (60 men [86%], median age 68 years [range 59 - 76 years]) were included. Twenty (29%) were ruptured at presentation. INAA location was thoracic in 11 (16%) cases, thoraco-abdominal in seven (10%), and abdominal in 50 (71%). Half of the abdominal INAAs were suprarenal. Two INAAs were concomitantly abdominal and thoracic. Pathogens were identified in 83%. The bacterial spectrum was scattered, with rare Salmonella species (n = 6; 9%). Open surgical repair was performed in 66 (94%) patients, including five conversions of initially attempted endovascular grafts (EVAR), three hybrid procedures, and one palliative EVAR. Vascular substitutes were cryopreserved arterial allografts (n = 67; 96%), prosthesis (n = 2), or femoral veins (n = 1). Kaplan-Meier estimates of overall survival at 30 and 90 days were 87% (95% confidence interval [CI] 76.6 - 93.0) and 71.7% (95% CI 59.2 - 80.9), respectively. The overall in hospital mortality rate was 27.9% (95% CI 1.8 - 66.5). IRCs occurred in seven (10%) patients. The median follow up period was 26.5 months (range 13.0-66.0 months). Chronic kidney disease (CKD) was independently related to in hospital mortality (odds ratio [OR] 20.7, 95% CI 1.8 - 232.7). American Society of Anesthesiologists score of 3 (OR 6.0, 95% CI 1.1 - 33.9), 4 (OR 14.9, 95% CI 1.7 - 129.3), and CKD (OR 32.0, 95% CI 1.2 - 821.5) were related to 90 day mortality.
Surgical INAA management has significant mortality and a low re-infection rate. EVAR necessitated secondary open repair, but its limited use in this report did not allow conclusions to be drawn.
真菌性/感染性原发性主动脉瘤（INAA）的治疗方式各异。鉴于相关文献参差不齐，本研究旨在评估INAA手术治疗的结果，并根据近期报告标准的建议提供全面数据。
对2002年9月至2020年3月期间在两家机构就诊的INAA患者进行回顾性研究。研究终点为住院死亡率、90天死亡率、总死亡率和感染相关并发症（IRC）。评估总生存率和无IRC生存率，并使用单变量和多变量分析测试死亡率的预测因素。
共纳入70例患者（60例男性[86%]，中位年龄68岁[范围59 - 76岁]）。20例（29%）就诊时为破裂性动脉瘤。INAA位于胸部的有11例（16%），胸腹联合部的有7例（10%），腹部的有50例（71%）。半数腹部INAA位于肾动脉上方。2例INAA同时累及腹部和胸部。83%的病例鉴定出病原体。细菌谱分散，罕见沙门氏菌属（n = 6；9%）。66例（94%）患者接受了开放手术修复，其中包括5例最初尝试血管腔内修复术（EVAR）后转为开放手术、3例杂交手术和1例姑息性EVAR。血管替代物为冷冻保存的动脉同种异体移植物（n = 67；96%）、人工血管（n = 2）或股静脉（n = 1）。30天和90天的Kaplan-Meier总生存率估计分别为87%（95%置信区间[CI] 76.6 - 93.0）和71.7%（95% CI 59.2 - 80.9）。总体住院死亡率为27.9%（95% CI 1.8 - 66.5）。7例（10%）患者发生IRC。中位随访期为26.5个月（范围13.0 - 66.0个月）。慢性肾脏病（CKD）与住院死亡率独立相关（比值比[OR] 20.7，95% CI 1.8 - 232.7）。美国麻醉医师协会评分为3分（OR 6.0，95% CI 1.1 - 33.9）、4分（OR 14.9，95% CI 1.7 - 129.3）以及CKD（OR 32.0，95% CI 1.2 - 821.5）与90天死亡率相关。
INAA的手术治疗有显著死亡率且再感染率低。EVAR需要二次开放修复，但本报告中其使用有限，无法得出结论。
