目的:这篇综述综合了最近关于腹主动脉移植物或移植物内感染(AGEI)的原位主动脉重建的文献,旨在报告与当前可用的血管替代品(VS)相关的单独结果。
方法:我们对2005年1月至2022年12月的所有已发表文献进行了系统回顾。我们纳入了有关腹部AGEIs开放手术治疗的文章,去除受感染的移植物并用生物或假体材料进行原位重建。不区分腹主动脉和胸主动脉相关结局的文章被排除。以及报告累积原位和解剖外重建结果的研究。
结果:通过数据库搜索确定的500条记录(发布:226;Embase:274),其中8人被列入本审查。总的来说,30天死亡率为8.7%(25/285),而最常见的早期并发症是呼吸道不良事件(46/346,13.3%)和肾功能恶化(26/85,30%).在250/350例(71.4%)中,利用了生物VS。在四篇文章中,不同类型的VSs的结果是联合呈现的。其余四份报告中分析的患者分为“生物学”和“假体”组(BG和PG)。BG和PG的累积死亡率分别为15.6%(33/212)和27%(9/33),分别,而BG中移植物再感染为6.3%(15/236),和9%(3/33)的PG。集中于自体静脉的文章报道的累积死亡率为14.8%(30/202),而其30天再感染率为5.7%(13/226)。
结论:由于腹部年龄并不常见,专注于不同类型的VS之间的直接比较的文献很少,特别是与自体静脉以外的材料有关时。尽管我们发现,仅使用生物材料或自体静脉治疗的患者的总死亡率较低,在最近的报道中,假体在死亡率和再感染率方面提供了有希望的结果。然而,现有的研究没有区分和比较不同类型的假体材料.建议进行大型多中心研究,特别是侧重于不同类型的VS及其比较。
BACKGROUND: This
review synthetizes recent literature about in-situ aortic reconstructions for abdominal aortic graft or endograft infections (AGEIs), aiming to report outcomes individually related to currently available vascular substitutes (VSs).
METHODS: We performed a systematic
review of all published literature from January 2005 to December 2022. We included articles reporting on open surgical treatment of abdominal AGEIs, with removal of the infected graft and in-situ reconstruction with biological or prosthetic material. Articles not distinguishing between abdominal and thoracic aortic-related outcomes were excluded, as well as studies reporting on cumulative in-situ and extra-anatomic reconstruction results.
RESULTS: Of 500 records identified through database searching (Pubmed: 226; Embase: 274), 8 of them were included in the present
review. Overall, 30-days mortality rate was 8.7% (25/285), while the most frequent early complications were respiratory adverse events (46/346, 13.3%) and renal function deterioration (26/85, 30%). In 250/350 cases (71.4%), a biological VS was utilized. In 4 articles, the outcomes of different types of VSs were presented jointly. Patients analyzed in the remaining 4 reports were sorted in a \"biological\" and a \"prosthetic\" group (BG and PG). The cumulative mortality rate of the BG and PG were 15.6% (33/212) and 27% (9/33), respectively, while graft reinfection was 6.3% (15/236) in the BG, and 9% (3/33) in the PG. The cumulative mortality rate reported in articles focused on autologous veins was 14.8% (30/202), while their 30-days reinfection rate was 5.7% (13/226).
CONCLUSIONS: Since abdominal AGEIs are uncommon conditions, literature focused on direct comparison between different types of VSs is scarce, particularly when related to materials other than autologous veins. Although we found a lower overall mortality rate in patients treated with biological material or with autologous veins only, in recent reports prosthesis provide promising results in terms of mortality and reinfection rate. However, none of the available studies distinguish and compares different types of prosthetic material. Large multicenter studies are advisable, especially focused on different types of VSs and their comparison.