感染性主动脉炎的紧急或急诊血管内主动脉修复术

Bernardo Orellana Dávila, Carlotta Mancusi, C. Coscarella, C. Spataro, Paolo Carfagna, A. Ippoliti, R. Giudice, C. Ferrer
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The inclusion criteria were clinical, laboratory, and radiological findings recognized as aortitis risk factors. Patients with graft or endograft infection, aortic fistulae, and mycotic aneurysm were excluded. Primary endpoints were technical success and 30-day and follow-up survival. Early and late major adverse events, any changes in lesion morphology over time, and need for re-intervention were also assessed. Results: A total of 15 patients (14 males and 1 female) with a mean age of 74.2 ± 8.3 were included. All the subjects were treated by endovascular means in an urgent or emergent setting because of a rapidly growing aneurysm, symptomatic lesion, or contained or free aortic rupture. The diagnosis of infective aortitis was confirmed postoperatively by positive blood cultures in all the patients. A rapidly growing or symptomatic lesion was noted in all 15 subjects. Among these there were six (40%) contained and two (13%) free aneurysm ruptures. 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引用次数: 0

摘要

背景:大动脉炎是一种罕见的主动脉炎症:主动脉炎是一种罕见的主动脉炎症。它可分为感染性、非感染性和特发性。感染性大动脉炎可表现为急性主动脉综合征,需要紧急或急诊治疗。从历史上看,这类患者最好接受开放手术治疗,但随后缺乏有关血管内修复的信息。本研究旨在报告我们对急性感染性大动脉炎进行紧急或急诊血管内修复的经验结果。方法:纳入2019年1月至2024年1月期间为治疗感染性大动脉炎而进行的所有连续紧急或急诊血管内修复术。纳入标准为临床、实验室和放射学检查结果均被认为是大动脉炎的危险因素。不包括移植物或内移植物感染、主动脉瘘和霉菌性动脉瘤患者。主要终点是技术成功率、30 天存活率和随访存活率。此外,还对早期和晚期的主要不良事件、病变形态随时间的变化以及是否需要再次介入进行了评估。结果:共纳入 15 名患者(14 男 1 女),平均年龄(74.2 ± 8.3)岁。所有受试者都是因动脉瘤快速生长、无症状病变、包含或游离主动脉破裂而在紧急或急诊情况下接受血管内治疗的。所有患者的感染性大动脉炎诊断均在术后通过阳性血液培养得到证实。在所有 15 名受试者中都发现了快速生长或有症状的病变。其中有六个(40%)包含动脉瘤破裂,两个(13%)游离动脉瘤破裂。所采用的血管内技术如下:四例胸腔-EVAR(TEVAR)、三例现成的分支-EVAR(BEVAR)、一例Chimney-EVAR(Ch-EVAR)、六例使用分叉移植物的EVAR和一例使用直管移植物的EVAR。100%的患者获得了技术成功。两名患者(13%)在指数手术后 30 天内死亡。没有出现与主动脉相关的早期死亡病例。在平均 31.6 ± 23.1 个月(1-71 个月)的随访期间,其余 13 名存活患者均未再发生死亡或重大不良事件。有三例患者(20%)接受了再次介入治疗。在修复后早期存活的 13 名患者中,有 10 名患者的动脉瘤缩小 > 5 毫米或趋于稳定。结论:尽管人们相对不愿意在感染区域使用血管内移植物,但根据我们的经验,血管内方法在治疗急性感染性主动脉炎方面是可行、安全和有效的,而且围手术期和中期随访结果也是可以接受的。我们需要进一步的研究来证实我们的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Urgent or Emergent Endovascular Aortic Repair of Infective Aortitis
Background: Aortitis is a rare inflammation of the aorta. It can be classified as infective, non-infective, or idiopathic. Infective aortitis can debut as an acute aortic syndrome that needs urgent or emergent treatment. Historically, these kinds of patients have been preferably treated by open surgery, with subsequent lack of information about the endovascular repair. The aim of the present study is to report the results of our experience with the urgent or emergent endovascular repair of infective aortitis with acute presentation. Methods: All consecutive urgent or emergent endovascular repairs, performed between January 2019 and January 2024 for the treatment of infective aortitis, were included. The inclusion criteria were clinical, laboratory, and radiological findings recognized as aortitis risk factors. Patients with graft or endograft infection, aortic fistulae, and mycotic aneurysm were excluded. Primary endpoints were technical success and 30-day and follow-up survival. Early and late major adverse events, any changes in lesion morphology over time, and need for re-intervention were also assessed. Results: A total of 15 patients (14 males and 1 female) with a mean age of 74.2 ± 8.3 were included. All the subjects were treated by endovascular means in an urgent or emergent setting because of a rapidly growing aneurysm, symptomatic lesion, or contained or free aortic rupture. The diagnosis of infective aortitis was confirmed postoperatively by positive blood cultures in all the patients. A rapidly growing or symptomatic lesion was noted in all 15 subjects. Among these there were six (40%) contained and two (13%) free aneurysm ruptures. The endovascular techniques performed were as follows: four thoracic-EVAR (TEVAR), three off-the-shelf branched-EVAR (BEVAR), one Chimney-EVAR (Ch-EVAR), six EVAR with bifurcated graft, and one EVAR with straight tube graft. Technical success was achieved in 100% of the patients. Two patients (13%) died within 30 days after the index procedure. No case of early aortic-related mortality was registered. During a mean follow-up of 31.6 ± 23.1 months (range 1–71), no further death or major adverse event was registered among the remaining 13 alive patients. Re-interventions were performed in three cases (20%). Aneurysm’s shrinkage > 5 mm or stability was noted in 10 of the 13 patients who survived the early period after repair. Conclusions: Despite the relative reluctance to use an endograft in an infected area, in our experience the endovascular approach resulted to be feasible, safe, and effective in the treatment of infective aortitis with acute presentation, with acceptable peri-operative and mid-term follow-up outcomes. Further studies are needed to confirm our results.
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