Abstract：
OBJECTIVE: Infected native aneurysms (INAs) of the abdominal aorta and iliac arteries are uncommon, but potentially fatal. Endovascular aneurysm repair (EVAR) has recently been introduced as a durable treatment option, with outcomes comparable to those yielded by conventional open repair. However, owing to the rarity of the disease, the strengths and limitations of each treatment remain uncertain. The present study aimed to separately assess post-open repair and post-EVAR outcomes and to clarify factors affecting the short-term and late prognosis after each treatment.
METHODS: Using a nationwide clinical registry, we investigated 600 patients treated with open repair and 226 patients treated with EVAR for INAs of the abdominal aorta and/or common iliac artery. The relationships between preoperative or operative factors and postoperative outcomes, including 90-day and 3-year mortality and persistent or recurrent aneurysm-related infection, were examined.
RESULTS: Prosthetic grafts were used in >90% of patients treated with open repair, and in situ and extra-anatomic arterial reconstruction was performed in 539 and 57 patients, respectively. Preoperative anemia and imaging findings suggestive of aneurysm-enteric fistula were independently associated with poor outcomes in terms of both 3-year mortality (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.01-2.62; P = .046, and HR, 2.24; 95% CI, 1.12-4.46; P = .022, respectively) and persistent or recurrent infection (odds ratio [OR], 2.16; 95% CI, 1.04-4.49; P = .039, and OR, 4.96; 95% CI, 1.81-13.55; P = .002, respectively) after open repair, whereas omental wrapping or packing and antibiotic impregnation of the prosthetic graft for in situ reconstruction contributed to improved 3-year survival (HR, 0.60; 95% CI, 0.39-0.92; P = .019, and HR, 0.53; 95% CI, 0.32-0.88; P = .014, respectively). Among patients treated with EVAR, abscess formation adjacent to the aneurysm was significantly associated with the occurrence of persistent or recurrent infection (OR, 2.24; 95% CI, 1.06-4.72; P = .034), whereas an elevated preoperative white blood cell count was predictive of 3-year mortality (HR, 1.77; 95% CI, 1.00-3.13; P = .048).
CONCLUSIONS: Profiles of prognostic factors differed between open repair and EVAR in the treatment of INAs of the abdominal aorta and common iliac artery. Open repair may be more suitable than EVAR for patients with concurrent abscess formation.
METHODS: Using a nationwide clinical registry, we investigated 600 patients treated with open repair and 226 patients treated with EVAR for INAs of the abdominal aorta and/or common iliac artery. The relationships between preoperative or operative factors and postoperative outcomes, including 90-day and 3-year mortality and persistent or recurrent aneurysm-related infection, were examined.
RESULTS: Prosthetic grafts were used in >90% of patients treated with open repair, and in situ and extra-anatomic arterial reconstruction was performed in 539 and 57 patients, respectively. Preoperative anemia and imaging findings suggestive of aneurysm-enteric fistula were independently associated with poor outcomes in terms of both 3-year mortality (hazard ratio [HR], 1.62; 95% confidence interval [CI], 1.01-2.62; P = .046, and HR, 2.24; 95% CI, 1.12-4.46; P = .022, respectively) and persistent or recurrent infection (odds ratio [OR], 2.16; 95% CI, 1.04-4.49; P = .039, and OR, 4.96; 95% CI, 1.81-13.55; P = .002, respectively) after open repair, whereas omental wrapping or packing and antibiotic impregnation of the prosthetic graft for in situ reconstruction contributed to improved 3-year survival (HR, 0.60; 95% CI, 0.39-0.92; P = .019, and HR, 0.53; 95% CI, 0.32-0.88; P = .014, respectively). Among patients treated with EVAR, abscess formation adjacent to the aneurysm was significantly associated with the occurrence of persistent or recurrent infection (OR, 2.24; 95% CI, 1.06-4.72; P = .034), whereas an elevated preoperative white blood cell count was predictive of 3-year mortality (HR, 1.77; 95% CI, 1.00-3.13; P = .048).
CONCLUSIONS: Profiles of prognostic factors differed between open repair and EVAR in the treatment of INAs of the abdominal aorta and common iliac artery. Open repair may be more suitable than EVAR for patients with concurrent abscess formation.
摘要：
目的：腹主动脉和髂动脉的感染性天然动脉瘤（INA）并不常见，但可能是致命的.血管内动脉瘤修复术（EVAR）最近被引入作为一种持久的治疗选择，结果与常规开放修复产生的结果相当。然而,由于这种疾病的罕见，每种治疗的优势和局限性仍不确定.本研究旨在分别评估开放修复后和EVAR后的结果，并阐明每种治疗后影响短期和晚期预后的因素。
方法：使用全国性的临床注册，我们调查了600例接受开放修复治疗的患者和226例接受EVAR治疗的患者的腹主动脉和/或髂总动脉INA.术前或手术因素与术后结局的关系，包括90天和3年死亡率以及持续性或复发性动脉瘤相关感染，进行了检查。
结果：>>90％的患者接受了开放修复治疗，539例和57例患者进行了原位和解剖外动脉重建，分别。就3年死亡率而言，贫血和提示动脉瘤-肠瘘的影像学表现与不良预后独立相关（风险比[HR]，1.62；95%置信区间[CI]，1.01-2.62；P=.046，HR，2.24；95%CI，1.12-4.46；P=0.022）和持续性或复发性感染（比值比[OR]，2.16；95%CI，1.04-4.49；P=0.039，OR，4.96；95%CI，1.81-13.55；分别为P=.002）开放修复后，而用于原位重建的假体移植物的网膜包裹或包装和抗生素浸渍有助于提高3年生存率(HR，0.60；95%CI，0.39-0.92；P=0.019，HR，0.53；95%CI，0.32-0.88；P=0.014）。在接受EVAR治疗的患者中，动脉瘤附近的脓肿形成与持续性或复发性感染的发生显着相关（OR，2.24；95%CI，1.06-4.72；P=0.034），而白细胞计数升高是3年死亡率的预测因素(HR，1.77；95%CI，1.00-3.13；P=0.048）。
结论：在腹主动脉和髂总动脉INA的治疗中，开放修复和EVAR的预后因素的概况不同。对于脓肿形成的患者，开放修复可能比EVAR更合适。
方法：使用全国性的临床注册，我们调查了600例接受开放修复治疗的患者和226例接受EVAR治疗的患者的腹主动脉和/或髂总动脉INA.术前或手术因素与术后结局的关系，包括90天和3年死亡率以及持续性或复发性动脉瘤相关感染，进行了检查。
结果：>>90％的患者接受了开放修复治疗，539例和57例患者进行了原位和解剖外动脉重建，分别。就3年死亡率而言，贫血和提示动脉瘤-肠瘘的影像学表现与不良预后独立相关（风险比[HR]，1.62；95%置信区间[CI]，1.01-2.62；P=.046，HR，2.24；95%CI，1.12-4.46；P=0.022）和持续性或复发性感染（比值比[OR]，2.16；95%CI，1.04-4.49；P=0.039，OR，4.96；95%CI，1.81-13.55；分别为P=.002）开放修复后，而用于原位重建的假体移植物的网膜包裹或包装和抗生素浸渍有助于提高3年生存率(HR，0.60；95%CI，0.39-0.92；P=0.019，HR，0.53；95%CI，0.32-0.88；P=0.014）。在接受EVAR治疗的患者中，动脉瘤附近的脓肿形成与持续性或复发性感染的发生显着相关（OR，2.24；95%CI，1.06-4.72；P=0.034），而白细胞计数升高是3年死亡率的预测因素(HR，1.77；95%CI，1.00-3.13；P=0.048）。
结论：在腹主动脉和髂总动脉INA的治疗中，开放修复和EVAR的预后因素的概况不同。对于脓肿形成的患者，开放修复可能比EVAR更合适。
