Gupta A K, Bandyk D F, Johnson B L
Department of Surgery, University of South Florida College of Medicine, Tampa, USA.
J Vasc Surg. 1996 Sep;24(3):472-6. doi: 10.1016/s0741-5214(96)70204-5.
Treatment of mycotic aortic aneurysm by excision and extraanatomic bypass is difficult to apply when the infectious process involves the visceral arteries. On the basis of experimental studies in our laboratory that demonstrated prolonged antistaphylococcal activity of rifampin-bonded, gelatin-impregnated Dacron grafts after implantation in the arterial circulation, this conduit was successfully used for in situ replacement of a native aortic infection in two patients. Both patients had fever, leukocytosis, abdominal or back pain, and a computed tomographic scan that demonstrated contained rupture of a mycotic aneurysm. Preoperative computed tomography-guided aspiration and culture of periaortic fluid from one patient grew Staphylococcus aureus. Treatment consisted of prolonged (6 weeks) culture-specific parenteral antibiotic therapy, excision of involved aorta, oxychlorosene irrigation of the aortic bed, and restoration of aortic continuity by in situ prosthetic replacement. A preliminary right axillobifemoral bypass was performed in the patient who had an infection involving the suprarenal and infrarenal aorta. In both patients intraoperative culture of aorta wall recovered S. aureus. Patients were discharged at 20 and 21 days. Clinical follow-up and computed tomographic imaging of the replacement graft beyond 10 months after surgery demonstrated no signs of residual aortic infection. In the absence of gross pus and frank sepsis, the use of an antibiotic-bonded prosthetic graft with antistaphylococcal activity should be considered in patients who have arterial infections caused by S. aureus when excision and ex situ bypass are not feasible.
当感染过程累及内脏动脉时，通过切除和解剖外旁路治疗霉菌性主动脉瘤很难实施。基于我们实验室的实验研究，该研究表明利福平结合、明胶浸渍的涤纶移植物在植入动脉循环后具有延长的抗葡萄球菌活性，这种管道已成功用于两名患者的原位替换天然主动脉感染。两名患者均有发热、白细胞增多、腹痛或背痛，计算机断层扫描显示霉菌性动脉瘤有局限性破裂。一名患者术前计算机断层扫描引导下对主动脉周围液体进行抽吸和培养，培养出金黄色葡萄球菌。治疗包括延长（6周）针对特定培养物的肠外抗生素治疗、切除受累主动脉、用氧氯苯醚冲洗主动脉床，以及通过原位假体置换恢复主动脉连续性。对一名感染累及肾上腺上和肾上腺下主动脉的患者进行了初步的右腋-双股旁路手术。两名患者主动脉壁的术中培养均发现金黄色葡萄球菌。患者分别在20天和21天出院。术后10个月以上对置换移植物的临床随访和计算机断层扫描成像显示没有残留主动脉感染的迹象。在没有大量脓液和明显败血症的情况下，对于由金黄色葡萄球菌引起动脉感染且切除和异位旁路不可行的患者，应考虑使用具有抗葡萄球菌活性的抗生素结合假体移植物。
