Torsello G, Sandmann W, Gehrt A, Jungblut R M
Department of Vascular Surgery and Kidney Transplantation, University of Düsseldorf, Germany.
J Vasc Surg. 1993 Apr;17(4):768-73. doi: 10.1067/mva.1993.40229.
Based on the excellent results of experimental studies with antibiotic-bonded vascular prostheses for prevention of graft infection, gelatin-sealed grafts soaked with rifampin were implanted in situ in five patients with vascular infection. All patients were at risk for limb loss or death and could not be treated by standard techniques such as graft excision and extra-anatomic bypass. In one patient an infected aortic stump aneurysm with involvement of both renal and visceral arteries was found. He was treated by implantation of a bifurcation rifampin-soaked graft between the subdiaphragmal aorta and both renal arteries and reimplantation of celiac and superior mesenteric artery into the graft. In four patients with in-flow or runoff problems on angiography, an antibiotic-soaked graft was used for replacement of a partially or totally infected graft. Cultures were positive for Staphylococcus aureus in three and coagulase-negative staphylococci in two patients. Wound healing was uncomplicated; there was no need for amputation. After a follow-up of at least 6 months, all grafts were patent without any evidence of reinfection on computed tomographic scan. We conclude that infected vascular prostheses can be replaced in situ by rifampin-soaked grafts in patients at high risk for death or major amputation.
基于使用抗生素结合血管移植物预防移植物感染的实验研究取得的优异成果，将浸泡有利福平的明胶密封移植物原位植入5例血管感染患者体内。所有患者均面临肢体丧失或死亡风险，无法通过移植切除和解剖外旁路等标准技术进行治疗。1例患者发现感染性主动脉残端动脉瘤，累及肾动脉和内脏动脉。对其治疗方法是在膈下主动脉和双侧肾动脉之间植入分叉的浸泡有利福平的移植物，并将腹腔干和肠系膜上动脉重新植入移植物。4例血管造影显示存在流入或流出问题的患者，使用浸泡有抗生素的移植物替换部分或全部感染的移植物。3例患者的培养结果显示金黄色葡萄球菌呈阳性，2例患者的凝固酶阴性葡萄球菌呈阳性。伤口愈合顺利；无需截肢。经过至少6个月的随访，所有移植物均通畅，计算机断层扫描未显示任何再感染迹象。我们得出结论，对于有死亡或大截肢高风险的患者，感染的血管移植物可通过浸泡有利福平的移植物原位替换。
