Khalid Wajih, Puges Mathilde, Stenson Katherine, Cazanave Charles, Ducasse Eric, Caradu Caroline, Berard Xavier
Department of Vascular Surgery, Bordeaux University Hospital, Bordeaux, France.
Department of Infectious Diseases, Bordeaux University Hospital, Bordeaux, France.
Eur J Vasc Endovasc Surg. 2023 Jan;65(1):149-158. doi: 10.1016/j.ejvs.2022.10.003. Epub 2022 Oct 6.
The increasing use of endovascular aneurysm repair (EVAR) appears to be associated with the burden of vascular endograft infections. Complete stent graft explantation is recommended but leads to significant mortality. This study aimed to assess the technical challenges, complications, and mortality rate following infected endograft explantation.
Patients who underwent abdominal aortic endograft explantation for infection at the Bordeaux University Hospital from July 2008 to December 2020 were included retrospectively in this single centre observational study. The diagnosis was established based on the MAGIC criteria. The primary endpoint was 30 day mortality. Secondary endpoints were 90 day and in hospital mortality, survival, and re-infection.
Thirty-four patients were included, median age 69 years (interquartile range [IQR] 65, 76), with four (12%) treated as an emergency. The median time from EVAR to explantation was 17.5 months (4.5 - 36.3). In situ reconstruction was carried out with prosthetic grafts in 24 patients (71%, including 23 antimicrobial grafts combining silver and triclosan), and biological grafts in 10 (five femoral veins, four arterial allografts, three bovine patches, one biosynthetic graft). Seventeen aorto-enteric fistulae (AEnF) were addressed with direct repair of the intestinal tract (n = 10/17; 59%) or resection and anastomosis (n = 7/17; 41%). The culture was polymicrobial in 12 patients (35%) and remained sterile in four (12%). The 30 day and in hospital mortality rates were 21% (n = 7) and 27% (n = 9). Twenty-five patients (73%) presented with early post-operative complications, requiring 16 revision procedures (47%). Over a median follow up of 16.2 months (IQR 8.3, 33.6), the mortality rate was 35% (n = 12; 11 aortic related; 32%), with two re-infections (6%), both after biological reconstruction (one for an AEnF).
Early morbidity and mortality remain high after complete infected endograft explantation, even in a high volume centre. Comparison with other treatment modalities in large multicentre cohorts might be of interest.
血管内动脉瘤修复术（EVAR）的使用日益增加，这似乎与血管内移植物感染的负担有关。建议完整取出支架移植物，但这会导致显著的死亡率。本研究旨在评估感染性移植物取出术后的技术挑战、并发症和死亡率。
对2008年7月至2020年12月在波尔多大学医院因感染而接受腹主动脉移植物取出术的患者进行回顾性纳入本单中心观察性研究。诊断依据MAGIC标准确定。主要终点是30天死亡率。次要终点是90天和住院期间死亡率、生存率和再感染情况。
纳入34例患者，中位年龄69岁（四分位间距[IQR]65,76），其中4例（12%）为急诊治疗。从EVAR到取出移植物的中位时间为17.5个月（4.5 - 36.3）。24例患者（71%）采用人工血管进行原位重建（包括23例结合银和三氯生的抗菌移植物），10例采用生物移植物（5例股静脉、4例动脉同种异体移植物、3例牛心包补片、1例生物合成移植物）。17例主动脉肠瘘（AEnF）采用肠道直接修复（n = 10/17；59%）或切除吻合术（n = 7/17；41%）处理。12例患者（35%）培养结果为多种微生物感染，4例（12%）培养结果无菌。30天和住院期间死亡率分别为21%（n = 7）和27%（n = 9）。25例患者（73%）出现早期术后并发症，需要进行16次翻修手术（47%）。中位随访16.2个月（IQR 8.3,33.6），死亡率为35%（n = 12；11例与主动脉相关；32%），2例再感染（6%），均发生在生物重建后（1例因AEnF）。
即使在大容量中心，完整取出感染性移植物后的早期发病率和死亡率仍然很高。在大型多中心队列中与其他治疗方式进行比较可能会有意义。
