Piano G
Department of Surgery, University of Chicago, Illinois, USA.
Surg Clin North Am. 1995 Aug;75(4):799-809. doi: 10.1016/s0039-6109(16)46700-9.
No set of rigid guidelines can replace a clinically rational and methodic approach to the patient with an infrainguinal graft infection. Some fundamental principles are common to infrainguinal graft infections that form the basis for selective management: 1. Graft preservation can be attempted when the graft is patent, the anastomosis is intact, and the patient is not septic. 2. Graft excision is mandatory when the patient presents with a thrombosed infected graft, anastomotic or graft hemorrhage, or significant systemic sepsis. 3. Graft preservation can be attempted in both vein and PTFE grafts but is not advised for Dacron grafts. This approach should be tempered by the extent and virulence of the underlying infection, especially when Pseudomonas aeruginosa is the pathologic organism. 4. Delayed hemorrhage and continued systemic sepsis represent early failures of graft preservation and mandate graft excision. 5. Revascularization may be accomplished through the infected bed, but it is generally prudent to proceed with extra-anatomic reconstruction utilizing alternative approaches to inflow and outflow vessels.
没有一套严格的指导方针能够取代对股下移植感染患者采取临床合理且有条不紊的治疗方法。对于股下移植感染存在一些共同的基本原则，这些原则构成了选择性治疗的基础：1. 当移植血管通畅、吻合口完整且患者无脓毒症时，可以尝试保留移植血管。2. 当患者出现血栓形成的感染性移植血管、吻合口或移植血管出血，或严重的全身脓毒症时，必须切除移植血管。3. 对于静脉和聚四氟乙烯移植血管都可以尝试保留，但不建议对涤纶移植血管这样做。这种方法应根据潜在感染的范围和毒力进行调整，尤其是当病原菌为铜绿假单胞菌时。4. 延迟性出血和持续的全身脓毒症表明移植血管保留早期失败，必须切除移植血管。5. 血管重建可以通过感染区域进行，但通常谨慎的做法是采用替代流入和流出血管的方法进行解剖外重建。
