Division of Vascular Surgery, University of Iowa Carver College of Medicine, Iowa City, IA.
Memorial Hospital Central, University of Colorado Healthcare, 1400 E Boulder St, Colorado Springs, CO 80909.
Semin Vasc Surg. 2024 Jun;37(2):258-276. doi: 10.1053/j.semvascsurg.2023.04.019. Epub 2023 May 1.
Infective native arterial aneurysms and inflammatory aortic aneurysms are rare but morbid pathologies seen by vascular surgeons in the emergency setting. Presentation is not always clear, and a full workup must be obtained before adopting a management strategy. Treatment is multidisciplinary and is tailored to every case based on workup findings. Imaging with computed tomography, magnetic resonance, or with fluorodeoxyglucose-positron emission tomography aids in diagnosis and in monitoring response to treatment. Open surgery is traditionally performed for definitive management. Endovascular surgery may offer an alternative treatment in select cases with acceptable outcomes. Neither technique has been proven to be superior to the other. Physicians should consider patient's anatomy, comorbidities, life expectancy, and goals of care before selecting an approach. Long-term pharmacological treatment, with antibiotics in case of infective aneurysms and immunosuppressants in case of inflammatory aneurysms, is usually required and should be managed in collaboration with infectious disease specialists and rheumatologists.
感染性真性动脉动脉瘤和炎症性主动脉瘤是血管外科医生在紧急情况下罕见但严重的病理学疾病。其表现并不总是明确的，在采用管理策略之前，必须进行全面的检查。治疗是多学科的，根据检查结果针对每个病例量身定制。计算机断层扫描、磁共振成像或氟脱氧葡萄糖正电子发射断层扫描的影像学检查有助于诊断和监测治疗反应。传统上，开放性手术用于确定性治疗。在某些情况下，腔内手术可能是一种可接受的替代治疗方法。这两种技术都没有被证明优于另一种。医生在选择治疗方法时应考虑患者的解剖结构、合并症、预期寿命和治疗目标。长期的药物治疗，感染性动脉瘤需要使用抗生素，炎症性动脉瘤需要使用免疫抑制剂，通常是必需的，并且应该与传染病专家和风湿病专家合作进行管理。
