主动脉腔内修复术后血管内支架感染诊治进展
Progress in diagnosis and treatment of aortic endovascular stent infection after endovascular aortic repair
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摘要: 主动脉血管内支架感染(AEI)是主动脉腔内修复术(EVER)后罕见的致死性并发症。其发生涉及多种因素, 积极预防病原微生物在支架上定植及附着能显著降低AEI的发生率。AEI临床表现缺乏特异性, 对于EVER术后出现不明原因发热、乏力、疼痛或炎症指标升高的患者, 应警惕AEI可能, 需积极完善实验室及影像学检查进一步明确。确诊AEI的患者, 能耐受手术者, 首选彻底清除感染材料及组织, 并根据患者情况重建血运及抗菌治疗;不能耐受手术者, 需进行长疗程或终身抗菌药物治疗, 可辅以经皮穿刺引流。严格筛选EVER患者、积极预防病原体定植、早期诊断及多学科联合治疗可显著降低AEI的发生率和病死率, 改善患者预后。Abstract: Aortic endovascular stent infection (AEI) is a rare and potentially fatal complication following endovascular aortic repair (EVER). Its occurrence involves multiple factors. Actively preventing the colonization and adhesion of pathogenic microorganisms on the stent can significantly reduce the incidence rate of AEI. The clinical manifestations of AEI are nonspecific. Patients who develop unexplained fever, fatigue, pain or elevated inflammatory markers after EVER should be alerted to the possibility of AEI and require laboratory and imaging examinations to be improved actively for further clarification. For patients diagnosed with AEI who can tolerate surgery, the preferred treatment is to thoroughly remove infected materials and tissues, and to reconstruct blood supply and administer antibacterial therapy according to the patient′s condition. For those who cannot tolerate surgery, long-term or lifelong antibacterial drug therapy is required, which can be supplemented by percutaneous puncture drainage. Strict screening of EVER patients, active prevention of pathogen colonization, early diagnosis and multidisciplinary combination treatment can significantly reduce the incidence and fatality rate of AEI, thereby improving patient prognosis.