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与α相关的感染性原发性主动脉瘤的外科治疗:一例报告。

Surgical treatment of a -related infective native aortic aneurysm: A case report.

作者信息

Vy Tran Thanh, Bang Ho Tat, Doan Ngoc Tuan Pham, Thuy Tran Thi Mai, Vu Phan Ton Ngoc, Cuong Lam Thao

机构信息

Thoracic and Vascular Department, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.

Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.

出版信息

SAGE Open Med Case Rep. 2024 Aug 22;12:2050313X241271883. doi: 10.1177/2050313X241271883. eCollection 2024.

DOI:10.1177/2050313X241271883
PMID:39185067
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11342435/
Abstract

Infective native abdominal aortic aneurysms are a life-threatening condition with a high mortality rate. We report the case of a 53-year-old male patient who presented with abdominal pain and fever. Laboratory results showed an elevated white blood cell count and C-reactive protein levels. Blood cultures detected species, and computed tomography revealed a saccular abdominal aortic aneurysm. After 14 days of preoperative antibiotic therapy, the patient underwent a successful surgical bypass from the descending thoracic aorta, through the diaphragm and muscle layers of the anterior abdominal wall, to the bilateral common femoral arteries. The patient was discharged after 30 days of hospitalization and continued antibiotic treatment for another 30 days. Follow-up clinical evaluations and imaging studies showed good recovery and no signs of infection. This case highlights the importance of combining appropriate antibiotic therapy with surgical intervention in managing infective native aortic aneurysms. In particular, an extra-anatomical approach from the descending aorta can be a viable option in selected cases of infected aortic aneurysms, providing an effective means to achieve thorough debridement and prevent future graft infections.

摘要

感染性原发性腹主动脉瘤是一种危及生命的疾病,死亡率很高。我们报告一例53岁男性患者,其表现为腹痛和发热。实验室检查结果显示白细胞计数和C反应蛋白水平升高。血培养检测到菌种,计算机断层扫描显示为囊状腹主动脉瘤。经过14天的术前抗生素治疗后,患者成功接受了从降主动脉经膈肌和前腹壁肌肉层至双侧股总动脉的手术搭桥。患者住院30天后出院,并继续接受30天的抗生素治疗。随访临床评估和影像学检查显示恢复良好,无感染迹象。该病例强调了在处理感染性原发性主动脉瘤时,将适当的抗生素治疗与手术干预相结合的重要性。特别是,在某些感染性主动脉瘤病例中,从降主动脉采用解剖外途径可能是一种可行的选择,为实现彻底清创和预防未来移植物感染提供了一种有效手段。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16bd/11342435/f0f3ed9f9eb0/10.1177_2050313X241271883-fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16bd/11342435/678f38986171/10.1177_2050313X241271883-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16bd/11342435/6c612df2bed9/10.1177_2050313X241271883-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16bd/11342435/040599b82298/10.1177_2050313X241271883-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16bd/11342435/f0f3ed9f9eb0/10.1177_2050313X241271883-fig4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16bd/11342435/678f38986171/10.1177_2050313X241271883-fig1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16bd/11342435/6c612df2bed9/10.1177_2050313X241271883-fig2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16bd/11342435/040599b82298/10.1177_2050313X241271883-fig3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/16bd/11342435/f0f3ed9f9eb0/10.1177_2050313X241271883-fig4.jpg

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本文引用的文献

1
Outcome in Patients after Autologous Femoral Vein Reconstruction for Primary Aortic Infection and Aortic Graft Infection: A Case Series.自体股静脉重建治疗原发性主动脉感染和移植物感染的患者结局:病例系列。
Ann Vasc Surg. 2022 Jul;83:240-250. doi: 10.1016/j.avsg.2021.11.012. Epub 2021 Dec 18.
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Mycotic pseudoaneurysm of the extracranial carotid artery, a severe and rare disease, a case report.颅外颈动脉霉菌性假性动脉瘤,一种严重罕见疾病,病例报告。
Int J Surg Case Rep. 2020;71:382-385. doi: 10.1016/j.ijscr.2020.03.032. Epub 2020 Apr 1.
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Systematic Review of the Management of Mycotic Aortic Aneurysms.
真菌性主动脉瘤的治疗方法的系统评价。
Eur J Vasc Endovasc Surg. 2019 Sep;58(3):426-435. doi: 10.1016/j.ejvs.2019.05.004. Epub 2019 Jul 16.
4
Revascularisation through the obturator foramen of lower limbs with a compromised ipsilateral groin due to infection.通过闭孔对因感染导致同侧腹股沟受损的下肢进行血管重建。
Ann R Coll Surg Engl. 2020 Jan;102(1):14-17. doi: 10.1308/rcsann.2019.0070. Epub 2019 Jun 3.
5
Editor's Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms.编辑推荐——欧洲血管外科学会(ESVS)2019年腹主动脉-髂动脉瘤管理临床实践指南
Eur J Vasc Endovasc Surg. 2019 Jan;57(1):8-93. doi: 10.1016/j.ejvs.2018.09.020. Epub 2018 Dec 5.
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The SCARE 2018 statement: Updating consensus Surgical CAse REport (SCARE) guidelines.SCARE 2018 声明:更新共识手术病例报告(SCARE)指南。
Int J Surg. 2018 Dec;60:132-136. doi: 10.1016/j.ijsu.2018.10.028. Epub 2018 Oct 18.
7
Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature.沙门氏菌属所致霉菌性动脉瘤:临床经验及文献综述
Braz J Med Biol Res. 2018 Jun 25;51(9):e6864. doi: 10.1590/1414-431X20186864.
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