Moneta G L, Taylor L M, Yeager R A, Edwards J M, Nicoloff A D, McConnell D B, Porter J M
Department of Surgery, Oregon Health Sciences University and Portland Department of Veteran's Affairs Hospital, 97201-3098, USA.
Am J Surg. 1998 May;175(5):396-9. doi: 10.1016/S0002-9610(98)00056-7.
We report results of infected aortic aneurysms treated by a single group over 20 years.
Retrospective review.
Seventeen patients were treated, 10 with infrarenal and 7 suprarenal infections. All had abdominal/back pain, 88% were febrile, 71% had leukocytosis, and 24% were hemodynamically unstable. The most common responsible organism was Staphylococcus aureus (29%) followed by Salmonella organisms (24%). All suprarenal infections were gram-positive organisms. Infrarenal infections were treated with preliminary axillofemoral bypass followed by aortic resection. Suprarenal infections were treated with either in situ prosthetic graft or patch repairs. Operative survival was 90% for infrarenal and 57% for suprarenal infections. Operative deaths occurred in the setting of overwhelming sepsis and/or severe preoperative hemodynamic instability. There was no limb loss, renal failure, or intestinal ischemia. Late deaths occurred in 4 patients at 1.3 to 6.3 years postoperatively and were unrelated to their aortic repairs. Nine patients remain alive with a median follow-up of 2 years. There have been no late aortic or graft infections.
In the absence of hemodynamic instability and uncontrolled sepsis, infected aortic aneurysms can be successfully repaired with durable results.
我们报告了一组在20年期间对感染性主动脉瘤的治疗结果。
回顾性研究。
共治疗17例患者，其中10例为肾下感染，7例为肾上感染。所有患者均有腹痛/背痛，88%发热，71%白细胞增多，24%血流动力学不稳定。最常见的病原体是金黄色葡萄球菌（29%），其次是沙门氏菌属（24%）。所有肾上感染均为革兰氏阳性菌。肾下感染先进行腋股旁路术，然后行主动脉切除术。肾上感染采用原位人工血管移植或补片修补术治疗。肾下感染手术生存率为90%，肾上感染为57%。手术死亡发生在严重脓毒症和/或术前严重血流动力学不稳定的情况下。无肢体丢失、肾衰竭或肠缺血。4例患者术后1.3至6.3年出现晚期死亡，与主动脉修复无关。9例患者存活，中位随访时间为2年。无晚期主动脉或移植物感染。
在无血流动力学不稳定和未控制的脓毒症情况下，感染性主动脉瘤可成功修复并获得持久疗效。
