Sessa C, Farah I, Voirin L, Magne J L, Brion J P, Guidicelli H
Service de Chirurgie Vasculaire, Hôpital A. Michallon, Grenoble, France.
Ann Vasc Surg. 1997 Sep;11(5):453-63. doi: 10.1007/s100169900075.
From 1976 to 1994 we performed surgical treatment of 18 infected aneurysms of the infrarenal abdominal aorta. The aneurysm had ruptured in nine patients: into the retroperitoneum in six patients, and into an adjacent structure in three patients (duodenum, inferior vena cava, left renal vein). Two patients had an associated spondylitis. Four patients were in shock at the time of surgical treatment. Six patients (including four patients with Salmonella infection and two patients with spondylitis) had positive preoperative blood cultures. Salmonella was the most common microorganism (27%). Anaerobes accounted for 16%. In situ replacement was performed in 13 patients including three procedures performed under emergency conditions with frank purulent infection. Extraanatomic bypass was performed in five patients. Early postoperative death occurred in two patients (11%) due to septic complications (rupture of aortic anastomosis in one patient and rupture of aortic stump in one patient). All surviving patients underwent prolonged antibiotic therapy for at least 6 weeks. Overall mortality secondary to infected aneurysm was 16%. Infection of the aortic graft occurred in four patients (38%) including two patients with Salmonella infection and one patient with spondylitis. One patient developed a false anastomotic aneurysm 6 months postoperatively and was treated by in situ arterial allograft replacement. Postoperative blood cultures were positive in two patients presenting spondylitis and infection of the aortic prosthesis occurred in one of these patients. In addition to rupture, poor prognostic factors included spondylitis and Salmonella infection that were found to greatly enhance the risk of postoperative graft infection following in situ reconstruction.
1976年至1994年期间，我们对18例肾下腹主动脉感染性动脉瘤进行了外科治疗。9例患者的动脉瘤已破裂：6例破入腹膜后间隙，3例破入相邻结构（十二指肠、下腔静脉、左肾静脉）。2例患者合并脊柱炎。4例患者在手术治疗时处于休克状态。6例患者（包括4例沙门氏菌感染患者和2例脊柱炎患者）术前血培养呈阳性。沙门氏菌是最常见的微生物（27%）。厌氧菌占16%。13例患者进行了原位置换，其中3例在存在明显脓性感染的紧急情况下进行。5例患者进行了解剖外旁路手术。2例患者（11%）术后早期因败血症并发症死亡（1例患者主动脉吻合口破裂，1例患者主动脉残端破裂）。所有存活患者均接受了至少6周的长期抗生素治疗。感染性动脉瘤的总体死亡率为16%。4例患者（38%）发生了主动脉移植物感染，包括2例沙门氏菌感染患者和1例脊柱炎患者。1例患者术后6个月出现假性吻合口动脉瘤，接受了原位动脉同种异体移植置换治疗。2例脊柱炎患者术后血培养呈阳性，其中1例发生了主动脉假体感染。除破裂外，不良预后因素包括脊柱炎和沙门氏菌感染，这些因素被发现会大大增加原位重建后术后移植物感染的风险。
