Puttini Ilaria, Kapalla Marvin, Braune Anja, Michler Enrico, Kröger Joselyn, Lutz Brigitta, Sakhalihasan Natzi, Trenner Matthias, Biro Gabor, Weber Wolfgang, Rössel Thomas, Reeps Christian, Eckstein Hans-Henning, Wolk Steffen, Knappich Christoph, Notohamiprodjo Susan, Busch Albert
Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, 80333 Munich, Germany.
Division of Vascular and Endovascular Surgery, Department for Visceral, Thoracic and Vascular Surgery, Medical Faculty Carl Gustav Carus, University Hospital, Technical University of Dresden, 01307 Dresden, Germany.
J Clin Med. 2024 Jan 3;13(1):269. doi: 10.3390/jcm13010269.
Vascular graft/endograft infection (VGEI) is a serious complication after aortic surgery. This study investigates VGEI and patient characteristics, PET/CT quantification before surgical or conservative management of VGEI and post-intervention outcomes in order to identify patients who might benefit from such a procedure. PET standard uptake values (SUV) were quantitatively assessed and compared to a non-VGEI cohort. The primary endpoints were in-hospital mortality and aortic reintervention-free survival at six months. Ninety-three patients (75% male, 65 ± 10 years, 82% operated) were included. The initial operation was mainly for aneurysm (67.7%: 31% EVAR, 12% TEVAR, 57% open aortic repair). Thirty-two patients presented with fistulae. PET SUV (target-to-liver ratio) showed 94% sensitivity and 89% specificity. Replacement included silver-coated Dacron (21.3%), pericardium (61.3%) and femoral vein (17.3%), yet the material did not influence the overall survival ( = 0.745). In-hospital mortality did not differ between operative and conservative treatment (19.7% vs. 17.6%, = 0.84). At six months, 50% of the operated cohort survived without aortic reintervention. Short- and midterm morbidity and mortality remained high after aortic graft removal. Neither preoperative characteristics nor the material used for reconstruction influenced the overall survival, and, with limitations, both the in-hospital and midterm survival were similar between the surgically and conservatively managed patients.
血管移植物/腔内移植物感染（VGEI）是主动脉手术后的一种严重并发症。本研究调查了VGEI及患者特征、VGEI手术或保守治疗前的PET/CT定量分析以及干预后的结果，以确定可能从此类手术中获益的患者。对PET标准摄取值（SUV）进行了定量评估，并与非VGEI队列进行比较。主要终点为住院死亡率和6个月时无主动脉再次干预的生存率。纳入了93例患者（75%为男性，65±10岁，82%接受了手术）。初始手术主要针对动脉瘤（67.7%：31%为腔内修复术、12%为胸主动脉腔内修复术、57%为开放性主动脉修复术）。32例患者出现瘘管。PET SUV（靶肝比值）显示敏感性为94%，特异性为89%。置换材料包括镀银涤纶（21.3%）、心包（61.3%）和股静脉（17.3%），但材料对总体生存率无影响（P = 0.745）。手术治疗和保守治疗的住院死亡率无差异（19.7%对17.6%，P = 0.84）。6个月时，50%的手术队列患者存活且未进行主动脉再次干预。主动脉移植物切除后，短期和中期的发病率和死亡率仍然很高。术前特征和用于重建的材料均不影响总体生存率，并且在有一定局限性的情况下，手术治疗和保守治疗患者的住院生存率和中期生存率相似。
