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Die In-situ-Rekonstruktion nach bakterieller Infektion der infrarenalen Aorta

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Zusammenfassung

Die bakterielle Aortitis ist mit einer hohen Letalität vergesellschaftet und stellt eine Komplikation systemischer oder auch lokalisierter Infektionen dar. Die Therapie umfasst In-situ oder extraanatomische Rekonstruktionen. Aufgrund der Seltenheit des Krankheitsbilds liegen keine größeren Serien oder gar vergleichende Studien vor. Ziel dieser Arbeit war, die Ergebnisse der In-situ-Prothesenimplantation hinsichtlich des Einheilens und rekurrenter Infekte zu untersuchen. Hierbei wird erstmalig die Verwendung einer silberbeschichteten Prothese beschrieben.

Zwischen Juni 1999 und November 2001 wurden 3 männliche Patienten—49, 67 und 75 Jahre alt—aufgrund einer bakteriellen Aortitis mit gedeckter Ruptur und infrarenalem Aneurysma spurium operiert. Bei 2 Patienten handelte es sich um einen serologisch nachgewiesenen Salmonelleninfekt, und einmal wurde ein extrem seltener Yersinieninfekt verifiziert. Es wurde zweimal eine silberimprägnierte Aortenrohrprothese und einmal eine aortobiiliakale Y-Prothese implantiert.

Nach In-situ Rekonstruktion, Ummantelung mit Antibiotikaträger und 8- bis 12-wöchiger postoperativer Antibiose kam es bei allen 3 Patienten zu einem guten Einheilen ohne Zeichen erneuter bakterieller Besiedelung. Die postoperativen Kontrollen erfolgten durch klinische Untersuchung, Sonographie und Computertomographie.

Unseres Erachtens ist die In-situ-Rekonstruktion mit silberbeschichteten Dacronprothesen nach retroperitonealem Débridement zur Wiederherstellung der Strombahn bei bakterieller Aortenwandinfektion mit gedeckter Ruptur die Therapie der Wahl, sofern keine ausgedehnte, purulente Infektion vorliegt. Zwingend erforderlich ist eine bis zu 3 Monate postoperativ dauernde Antibiose. Sollte es dennoch zu einem periprothetischem Infekt kommen, kann dann auf ein extraanatomisches Verfahren umgestiegen werden.

Abstract

Bacterial infection of the aorta has a high mortality rate. It is a complication of systemic or localized infections. The options for therapy include in situ or extra-anatomic reconstruction. There are no controlled or randomized studies comparing the different treatments because of a very low incidence. The aim of this study is to report the results, after in situ reconstruction, of recurrent infection. The use of a silver impregnated prosthesis is described for the first time in bacterial aortitis.

Between June 1999 and November 2001, we operated on three male patients, 49, 67 and 75 years old, with bacterial aortitis as well as rupture and infrarenal aortic aneurysm. In two cases, we detected a Samonella infection and the other patient suffered from an extremely rare Yersinia infection. We implanted two silver impregnated Dacron prostheses as tube grafts and one aorto-biiliac bifurcated Dacron graft.

All three patients showed primary healing without recurrent infection after in situ reconstruction, covering with an antibiotic carrier and a 3 months postoperative treatment with antibiotics. The follow-up consist of clinical examination, ultrasound and computed tomography.

We conclude that in situ reconstruction with silver impregnated Dacron prostheses combined with retroperitoneal debridement is an excellent therapy option for the treatment of a bacterial wall infection of the aorta with rupture but without a severe purulent infection. If a periprosthetic infection is observed in the future, the possibility of an extra-anatomic revascularisation still exists.

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  1. Abteilung Gefäßchirurgie, Krankenhaus München-Neuperlach

    C. Wack & H. Niedermeier

  2. Abteilung Gefäßchirurgie, Krankenhaus München-Neuperlach, Oskar-Maria-Graf Ring 51, 81737, München

    C. Wack

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Wack, C., Niedermeier, H. Die In-situ-Rekonstruktion nach bakterieller Infektion der infrarenalen Aorta. Gefässchirurgie 8, 317–321 (2003). https://doi.org/10.1007/s00772-003-0295-2

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