Zusammenfassung
Die Infektion einer Aortenprothese ist eine seltene aber lebensbedrohliche Komplikation. Das übliche Vorgehen besteht in der Entfernung der infizierten Prothese, der extraanatomischen Rekonstruktion bzw. dem Einsatz von homologen Ersatzmaterialien. Alternativ kann die Revaskularisation mit körpereigenen Venen und Arterien durchgeführt werden. Alle Operationstechniken weisen gerade in der septischen Phase eine hohe Morbidität und Mortalität auf.
Eine weitere meist unbekannte Behandlungsmöglichkeit der infizierten Aortenprothese besteht in dem perkutanen Einbringen einer Drainage in Kombination mit einer gezielten mehrfachen Antibiose, die sich aus der mikrobiologischen Analyse des putriden Punktats und der möglichen Resistenzbestimmung ergibt. Die Drainagenbehandlung kann zumindest initial eine wertvolle Behandlungsoption sein, da sie bei geringer Komplikationsrate eine kurative Chance aufweist, zumindest Zeit gewinnen hilft und erst nach ihrem Versagen die chirurgischen Operationstechniken unter optimierten Bedingungen elektiv eingesetzt werden müssen.
Abstract
Graft infection is an uncommon but potentially lethal complication of aortic repair. The standard operation is to remove of the infected aortic graft followed by extra-anatomic reconstruction or the use of homologous graft material. A possible alternative method is the application of femoropopliteal veins and arteries to revascularize the abdominal aorta. All surgical procedures have a high rate of morbidity and mortality.
A further, largely unknown possibility to treat patients with an aortic graft infection is primary conservative drainage in combination with a specific multitherapeutic antibiotic regimen which is determined by microbiological analysis of the putrid puncture and by ascertaining antibiotic resistance. Percutaneous drainage seems to be a valuable tool in the initial treatment of aortic graft infection with less complications and the chance of a cure. In the case of failure, surgical revascularization procedures can be performed under improved or optimal conditions.
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Moll, R., Debus, S., Franke, S. et al. Diagnostik von infizierten Aortenprothesen und die Option zu einem konservativen Management mit Hilfe der perkutanen Drainage. Gefässchirurgie 8, 312–316 (2003). https://doi.org/10.1007/s00772-003-0298-z
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DOI: https://doi.org/10.1007/s00772-003-0298-z