Abstract：
Primary infected aneurysms of the abdominal aorta and iliac arteries are potentially life-threatening. However, because of the rarity of the disease, its pathogenesis and optimal treatment strategy remain poorly defined.
A nationwide retrospective cohort study investigated patients who underwent surgical treatment for a primary infected abdominal aortic and/or common iliac artery (CIA) aneurysm between 2011 and 2017 using a Japanese clinical registry. The study evaluated the relationships between preoperative factors and postoperative outcomes including 90-day and 3-year mortality, and persistent or recurrent aneurysm-related infection. Propensity score matching was used to compare survival between patients who underwent in situ prosthetic grafting and those who had endovascular aneurysm repair (EVAR).
Some 862 patients were included in the analysis. Preceding infection was identified in 30.2 per cent of the patients. The median duration of postoperative follow-up was 639 days. Cumulative overall survival rates at 30 days, 90 days, 1 year, 3 years and 5 years were 94.0, 89.7, 82.6, 74.9 and 68.5 per cent respectively. Age, preoperative shock and hypoalbuminaemia were independently associated with short-term and late mortality. Compared with open repair, EVAR was more closely associated with persistent or recurrent aneurysm-related infection (odds ratio 2.76, 95 per cent c.i. 1.67 to 4.58; P < 0.001). Propensity score-matched analyses demonstrated no significant differences between EVAR and in situ graft replacement in terms of 3-year all-cause and aorta-related mortality rates (P = 0.093 and P =0.472 respectively).
In patients undergoing surgical intervention for primary infected abdominal aortic and CIA aneursyms, postoperative survival rates were encouraging. Eradication of infection following EVAR appeared less likely than with open repair, but survival rates were similar in matched patients between EVAR and in situ graft replacement.
A nationwide retrospective cohort study investigated patients who underwent surgical treatment for a primary infected abdominal aortic and/or common iliac artery (CIA) aneurysm between 2011 and 2017 using a Japanese clinical registry. The study evaluated the relationships between preoperative factors and postoperative outcomes including 90-day and 3-year mortality, and persistent or recurrent aneurysm-related infection. Propensity score matching was used to compare survival between patients who underwent in situ prosthetic grafting and those who had endovascular aneurysm repair (EVAR).
Some 862 patients were included in the analysis. Preceding infection was identified in 30.2 per cent of the patients. The median duration of postoperative follow-up was 639 days. Cumulative overall survival rates at 30 days, 90 days, 1 year, 3 years and 5 years were 94.0, 89.7, 82.6, 74.9 and 68.5 per cent respectively. Age, preoperative shock and hypoalbuminaemia were independently associated with short-term and late mortality. Compared with open repair, EVAR was more closely associated with persistent or recurrent aneurysm-related infection (odds ratio 2.76, 95 per cent c.i. 1.67 to 4.58; P < 0.001). Propensity score-matched analyses demonstrated no significant differences between EVAR and in situ graft replacement in terms of 3-year all-cause and aorta-related mortality rates (P = 0.093 and P =0.472 respectively).
In patients undergoing surgical intervention for primary infected abdominal aortic and CIA aneursyms, postoperative survival rates were encouraging. Eradication of infection following EVAR appeared less likely than with open repair, but survival rates were similar in matched patients between EVAR and in situ graft replacement.
摘要：
腹主动脉和髂动脉的原发性感染动脉瘤可能危及生命。然而,由于这种疾病的罕见，其发病机制和最佳治疗策略仍不明确。
一项全国性的回顾性队列研究调查了2011年至2017年期间因原发性感染的腹主动脉和/或髂总动脉（CIA）动脉瘤接受手术治疗的患者。该研究评估了术前因素与术后结局之间的关系，包括90天和3年死亡率。和持续性或复发性动脉瘤相关感染。倾向评分匹配用于比较接受原位假体移植的患者和接受血管内动脉瘤修复术（EVAR）的患者之间的生存率。
约862名患者被纳入分析。在30.2%的患者中发现了先前的感染。术后随访的中位时间为639天。30天的累积总生存率，90天,1年,3年和5年分别为94.0%、89.7%、82.6%、74.9%和68.5%。年龄,术前休克和低白蛋白血症与短期和晚期死亡率独立相关.与开放式维修相比，EVAR与持续性或复发性动脉瘤相关感染更密切相关(比值比2.76,95%c.i.1.67至4.58;P<0.001)。倾向评分匹配分析显示，EVAR和原位移植物置换术在3年全因死亡率和主动脉相关死亡率方面没有显着差异（分别为P=0.093和P=0.472）。
在接受原发性感染腹主动脉和CIA动脉瘤手术干预的患者中，术后生存率令人鼓舞.与开放修复相比，EVAR后根除感染的可能性较小，但在EVAR和原位移植物置换的匹配患者中,存活率相似.
一项全国性的回顾性队列研究调查了2011年至2017年期间因原发性感染的腹主动脉和/或髂总动脉（CIA）动脉瘤接受手术治疗的患者。该研究评估了术前因素与术后结局之间的关系，包括90天和3年死亡率。和持续性或复发性动脉瘤相关感染。倾向评分匹配用于比较接受原位假体移植的患者和接受血管内动脉瘤修复术（EVAR）的患者之间的生存率。
约862名患者被纳入分析。在30.2%的患者中发现了先前的感染。术后随访的中位时间为639天。30天的累积总生存率，90天,1年,3年和5年分别为94.0%、89.7%、82.6%、74.9%和68.5%。年龄,术前休克和低白蛋白血症与短期和晚期死亡率独立相关.与开放式维修相比，EVAR与持续性或复发性动脉瘤相关感染更密切相关(比值比2.76,95%c.i.1.67至4.58;P<0.001)。倾向评分匹配分析显示，EVAR和原位移植物置换术在3年全因死亡率和主动脉相关死亡率方面没有显着差异（分别为P=0.093和P=0.472）。
在接受原发性感染腹主动脉和CIA动脉瘤手术干预的患者中，术后生存率令人鼓舞.与开放修复相比，EVAR后根除感染的可能性较小，但在EVAR和原位移植物置换的匹配患者中,存活率相似.
