Department of Vascular Surgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Japanese Society for Vascular Surgery, Tokyo, Japan.
Ann Surg. 2023 Apr 1;277(4):e963-e970. doi: 10.1097/SLA.0000000000005293. Epub 2021 Nov 11.
This study aimed to clarify the clinical features, postoperative outcomes, and prognostic factors in patients with endograft infection in the abdominal aorta and iliac artery.
Endograft infection in the abdominal aorta and iliac artery is a potentially fatal condition. However, due to its rarity, clinical characteristics and optimal treatment strategy remain to be established.
In this nationwide retrospective cohort study, we investigated 112 patients who underwent surgical treatment for endograft infection in the abdominal aorta and/or iliac artery between 2011 and 2017 using a Japanese clinical registry. We examined the relationships between the preoperative and operative factors and the outcomes after surgery including persistent or recurrent infection related to the endograft and 90-day and 3-year mortality.
The median period between the index endograft placement and surgery for infection was 369.5 days. Persistent or recurrent endograft-related infection occurred in 34 patients (30.4%). The cumulative overall survival rates at 30 days, 90 days, 1 year, 3 years, and 5 years were 90.2%, 76.5%, 66.7%, 50.9%, and 31.5%, respectively. Partial removal or total preservation of the infected endograft was independently associated with short-term and late mortality. Preoperative anemia and imaging findings suggestive of fistula development to the gastrointestinal tract also showed an independent association with late mortality.
Surgical intervention for endograft infection in the abdominal aorta and iliac artery was associated with a high risk of postoperative morbidity and mortality. Total removal of the infected endograft should be attempted because partial removal or total preservation can lead to a poor prognosis.
本研究旨在阐明腹主动脉和髂动脉移植物感染患者的临床特征、术后结果和预后因素。
腹主动脉和髂动脉移植物感染是一种潜在的致命疾病。然而，由于其罕见性，临床特征和最佳治疗策略仍有待确定。
在这项全国性回顾性队列研究中，我们使用日本临床注册中心调查了 2011 年至 2017 年间接受手术治疗的 112 例腹主动脉和/或髂动脉移植物感染患者。我们检查了术前和术中因素与术后结果之间的关系，包括与移植物相关的持续性或复发性感染以及 90 天和 3 年死亡率。
指数移植物放置与感染手术之间的中位时间为 369.5 天。34 例患者（30.4%）发生持续性或复发性移植物相关感染。30 天、90 天、1 年、3 年和 5 年的总生存率分别为 90.2%、76.5%、66.7%、50.9%和 31.5%。感染移植物的部分切除或全部保留与短期和晚期死亡率独立相关。术前贫血和影像学检查提示与胃肠道瘘形成有关也与晚期死亡率独立相关。
腹主动脉和髂动脉移植物感染的手术干预与术后发病率和死亡率高相关。应尝试完全切除感染的移植物，因为部分切除或全部保留可能导致预后不良。
