2012 г. №1 Том 20

ЛЕКЦИИ, ОБЗОРЫ

А.А. ЛЫЗИКОВ

ХИРУРГИЧЕСКАЯ ТАКТИКА ПРИ ИHФИЦИРОВАHИИ ИСКУССТВЕHHЫХ ПРОТЕЗОВ СОСУДОВ

УО «Гомельский государственный медицинский университет»,
Республика Беларусь

В обзоре описаны различные варианты хирургической тактики при нагноении протезов сосудов. Приведены основные виды хирургической тактики, такие, как: экстраанатомическое шунтирование, использование искусственных протезов, применение аллографтов и бедренной вены. Указаны достоинства и недостатки каждого метода. Проведен сравнительный анализ используемых методик. Определены показания и противопоказания для каждого способа. Описаны ситуации, в которых возможно предпринять попытку консервативного ведения нагноившегося протеза, а также применение искусственных протезов для репротезирования. Подробно изложены возможные пути предотвращения инфицирования протезов сосудов. Также описаны различные подходы к антибиотикопрофилактике нагноений сосудистых протезов. Приведено поэтапное развитие методов профилактики инфекционных осложнений со стороны искусственного протеза.

Ключевые слова: инфекция протеза, экстраанатомическое шунтирование, бедренная вена, аллографт, искусственный протез
с. 120 – 126 оригинального издания
Список литературы

1.O'Hara PJ, Hertzer NR, Beven EG, Krajewski LP. Surgical management of infected abdominal aortic grafts: review of a 25-year experience. J Vasc Surg. 1986 May;3(5):725–31.
2.Reilly LM, Stoney RJ, Goldstone J, Ehrenfeld WK. Improved management of aortic graft infection: the influence of operation sequence and staging. J Vasc Surg. 1987 Mar;5(3):421–31.
3.Quinones-Baldrich WJ, Hernandez JJ, Moore WS. Long-term results following surgical management of aortic graft infection. Arch Surg.126:507–12.
4.Ricotta JJ, Faggioli GL, Stella A, Curl GR, Peer R, Upson J, D'Addato M, Anain J, Gutierrez I. Total excision and extra-anatomic bypass for aortic graft infection. Am J Surg. 1991 Aug;162(2):145–49.
5.Leather RP, Darling RC 3rd, Chang BB, Shah DM. Retroperitoneal in-line aortic bypass for treatment of infected infrarenal aortic grafts. Surg Gynecol Obstet. 1992 Dec;175(6):491–94.
6.Olah A, Vogt M, Laske A, Carrell T, Bauer E, Turina M. Axillo-femoral bypass and simultaneous removal of the aortofemoral vascular infection site: is the procedure safe? Eur J Vasc Surg. 1992 May;6(3):252–54.
7.Bacourt F, Koskas F. Axillobifemoral bypass and aortic exclusion for vascular septic lesions: a multicenter retrospective study of 98 cases and the French University Association for Research in Surgery. Ann Vasc Surg. 1992; 6:119–21.
8.Bandyk DF, Novotney ML, Back MR, Johnson BL, Schmacht DC. Expanded application of in situ replacement for prosthetic graft infection. J Vasc Surg. 2001 Sep;34(3):411–19; discussion 419–20.
9.Clagett GP, Bowers BL, Lopez-Viego MA, Rossi MB, Valentine RJ, Myers SI, Chervu A. Creation of a neo-aortoiliac system from lower extremity deep and superficial veins. Ann Surg. 1993 Sep;218(3):239–48; discussion 248–49.
10.Nevelsteen A, Lacroix H, Suy R. Autogenous reconstruction with the lower extremity deep veins: an alternative treatment of prosthetic infection after reconstructive surgery for aortoiliac disease. J Vasc Surg. 1995;22:129–32.
11.Clagett GP, Valentine RJ, Hagino RT. Autogenous aortoiliac/femoral reconstruction from superficial femoral-popliteal veins: feasibility and disability. Vasc Surg. 1997;(5):55–68.
12.Franke S, Voit R. The superficial femoral vein as arterial substitute in infections of the aortoiliac region. Ann Vasc Surg. 1997;(11):406–15.
13. Brown PM Jr, Kim VB, Lalikos JF, Deaton DH, Bogey WM, Powell CS. Autologous superficial femoral vein for aortic reconstruction in infected fields. Ann Vasc Surg. 1999 Jan;13(1):32–6.
14.Cardozo MA, Frankini AD, Bonamigo TP. Use of superficial femoral vein in the treatment of infected aortoiliofemoral prosthetic grafts. Cardiovasc Surg. 2002;(10):304–13.
15.Gibbons CP, Ferguson CJ, Fligelstone LJ, Edwards K. Experience with femoro-popliteal vein as a conduit for vascular reconstruction in infected fields. Eur J Vasc Endovasc Surg. 2003 May;25(5):424–31.
16.Daenens K, Fourneau I, Nevelsteen A. Ten-year experience in autogenous reconstruction with the femoral vein in the treatment of aortofemoral prosthetic infection. Eur J Vasc Endovasc Surg. 2003;25:240–54.
17.Kieffer E, Bahnini A, Koskas F, Ruotolo C, Le Blevec D, Plissonnier D. In situ allograft replacement of infected infrarenal aortic prosthetic grafts: results in forty-three patients. J Vasc Surg. 1993 Feb;17(2):349-55; discussion 355–56.
18.Vogt PR, Pfammatter T, Schlumpf R, Genoni M, Kunzli A, Candinas D, Zund G, Turina M. In situ repair of aorto-bronchial, aortoesophageal, and aortoenteric fistulae with cryopreserved aortic homografts. J Vasc Surg. 1997 Jul;26(1):11–7.
19.Ruotolo C, Plissonnier D, Bahnini A, Koskas F, Kieffer E. In situ arterial allografts: a new treatment for aortic prosthetic infection. Eur J Vasc Endovasc Surg. 1997 Dec;14(Suppl. A):102–107.
20.Nevelsteen A, Feryn T, Lacroix H, Suy R, Goffin Y. Experience with cryopreserved arterial allografts in the treatment of prosthetic graft infections. Cardiovasc Surg. 1998 Aug;6(4):378–83.
21.Chiesa R, Astore D, Piccolo G, Melissano G, Jannello A, Frigerio D, Agrifoglio G, Bonalumi F, Corsi G, Costantini Brancadoro S, Novali C, Locati P, Odero A, Pirrelli S, Cugnasca M, Biglioli P, Sala A, Polvani G, Guarino A, Biasi GM, Mingazzini P, Scalamogna M, Mantero S, Spina G, Prestipino F, et al. Fresh and cryopreserved arterial homografts in the treatment of prosthetic graft infections: experience of the Italian Collaborative Vascular Homograft Group. Ann Vasc Surg. 1998 Sep;12(5):457–62.
22.Leseche G, Castier Y, Petit MD, Bertrand P, Kitzis M, Mussot S, Besnard M, Cerceau O.Long-term results of cryopreserved arterial allograft reconstruction in infected prosthetic grafts and mycotic aneurysms of the abdominal aorta. J Vasc Surg. 2001 Oct;34(4):616–22.
23.Verhelst R, Lacroix V, Vraux H, Lavigne JP, Vandamme H, Limet R, Nevelsteen A, Bellens B, Vasseur MA, Wozniak B, Goffin Y. Use of cryopreserved arterial homografts for management of infected prosthetic grafts: a multicentric study. Ann Vasc Surg. 2000 Nov;14(6):602–07.
24.Vogt PR, Brunner-LaRocca HP, Lachat M, Ruef C, Turina MI. Technical details with the use of cryopreserved arterial allograft for aortic infection: influence on early and midterm mortality. J Vasc Surg. 2002 Jan;35(1):80–6.
25.Noel AA, Gloviczki P, Cherry KJ Jr, Safi H, Goldstone J, Morasch MD, Johansen KH; United States Cryopreserved Aortic Allograft Registry Abdominal aortic reconstruct in infected fields: early results of the United States Cryopreserved Aortic Allograft Registry. J Vasc Surg. 2002 May;35(5):847–52.
26.Gabriel M, Pukacki F, Dzieciuchowicz L, Oszkinis G, Checinski P. Cryopreserved arterial allografts in the treatment of prosthetic graft infections. Eur J Vasc Endovasc Surg. 2004 Jun;27(6):590–96.
27.Teebken OE, Pichlmaier MA, Brand S, Haverich A. Cryopreserved arterial allografts for in situ reconstruction of infected arterial vessels. Eur J Vasc Endovasc Surg. 2004 Jun;27(6):597–602.
28.Lavigne JP, Postal A, Kolh P, Limet R. Prosthetic vascular infection complicated or not by aortoenteric fistula: comparison of treatment with and without cryopreserved allograft (homograft). Eur J Vasc Endovasc Surg. 2003 May;25(5):416–23.
29.Kieffer E, Gomes D, Chiche L, Fleron MH, Koskas F, Bahnini A. Allograft replacement for intrarenal aortic graft infection: early and late results in 179 patients. J Vasc Surg. 2004 May;39(5):1009–17.
30. Walker WE, Cooley DA, Duncan JM, Hallman GL Jr, Ott DA, Reul GJ. The management of aorto-duodeoal fistula by in situ replacement of the infected abdominal aortic graft. Ann Surg. 1987 Jun;205(6):727–32.
31.Speziale F, Rizzo L, Sbarigia E, Giannoni MF, Massucci M, Maraglino C, Santoro E, Fiorani P. Bacterial and clinical criteria relating to the outcome of patients undergoing in situ replacement of infected abdominal aortic grafts. Eur J Vasc Endovasc Surg. 1997 Feb;13(2):127–33.
32.Hayes PD, Nasim A, London NJ, Sayers RD, Barrie WW, Bell PR, Naylor AR.
In situ replacement of infected aortic grafts with rifampicin-bonded prostheses: the Leicester experience 1992 to 1998). J Vasc Surg. 1999 Jul;30(1):92–98.
33.Young RM, Cherry KJ Jr, Davis PM, Gloviczki P, Bower TC, Panneton JM, Hallett JW Jr. The results of in situ prosthetic replacement for infected aortic grafts. Am J Surg. 1999 Aug;178(2):136–40.
34.Batt M, Magne JL, Alric P, Muzj A, Ruotolo C, Ljungstrom KG, Garcia-Casas R, Simms M. In situ revascularization with silver-coated polyester grafts to treat aortic infection: early and midterm results. J Vasc Surg. 2003 Nov;38(5):983–89.
35.Lehnert T, Gruber HP, Maeder N, Allenberg JR. Management of primary aortic graft infection by extra-anatomic bypass reconstruction. Eur J Vasc Surg. 1993 May;7(3):301–307.
36.Sharp WJ, Hoballah JJ, Mohan CR, Kresowik TF, Martinasevic M, Chalmers RT, Corson JD The management of the infected aortic prosthesis: a current decade of experience. J Vasc Surg. 1994 May;19(5):844–50.
37.Kuestner LM, Reilly LM, Jicha DL, Ehrenfeld WK, Goldstone J, Stoney RJ. Secondary aortoenteric fistula: contemporary outcome with use of extraanatomic bypass and infected graft excision. J Vasc Surg. 1995 Feb;21(2):184–95; discussion 195–96.
38.Hannon RJ, Wolfe JHN, Mansfield AO. Aortic prosthetic infection: 50 patients treated by radical or local surgery. Br J Surg. 1996;83:654–59.
39.Schmitt DD, Seabrook GR, Bandyk DF, Towne JB. Graft excision and extra-anatomic revascularization: the treatment of choice for the septic aortic prosthesis. J Cardiovasc Surg (Torino). 1990 May-Jun;31(3):327–32.
40.Bunt TJ. Vascular graft infections: a personal experience. Cardiovasc Surg. 1993;(1):489–93.
41.Seeger JM, Pretus HA, Welborn MB, Ozaki CK, Flynn TC, Huber TS. Long-term outcome after treatment of aortic graft infection with staged extraanatomic bypass grafting and aortic graft removal. J Vasc Surg. 2000 Sep;32(3):451–59; discussion 460–61.
42.Dorigo W, Pulli R, Azas L, Pratesi G, Innocenti AA, Pratesi C. Early and long-term results of conventional surgical treatment of secondary aorto-enteric fistula. Eur J Vasc Endovasc Surg. 2003 Nov;26(5):512–18.
43.Yeager RA, Taylor LM Jr, Moneta GL, Edwards JM, Nicoloff AD, McConnell DB, Porter JM.Improved results with conventional management of infrarenal aortic infection. J Vasc Surg. 1999 Jul;30(1):76–83.
44.Modrall JG, Sadjadi J, Ali AT, Anthony T, Welborn MB 3rd, Valentine RJ, Hynan LS, Clagett GP. Deep vein harvest: predicting the need of fasciotomy. J Vasc Surg. 2004 Feb;39(2):387–94.
45.Koskas F, Plissonnier D, Bahnini A, Ruotolo C, Kieffer E. In situ arterial allografting for aortoiliac graft infection: a 6-year experience. Cardiovasc Surg. 1996 Aug;4(4):495–99.
46.Calligaro KD, Veith FJ, Schwartz ML, Goldsmith J, Savarese RP, Dougherty MJ, DeLaurentis DA.Selective preservation of infected prosthetic arterial grafts. Analysis of a 20-year experience with 120 extracavitary-infected grafts. Ann Surg. 1994 Oct;220(4):461–69; discussion 469–71.
47.Morris GE, Friend PJ, Vassallo DJ, Farrington M, Leapman S, Quick CR. Antibiotic irrigation and con-servative surgery for major aortic graft infection. J Vasc Surg. 1994 Jul;20(1):88–95.
48.Belair M, Soulez G, Oliva VL, Laperriere J, Gianfelice D, Blair JF, Sarrazin J, Therasse E. Aortic graft infection: the value of percutaneous drainage. AJR Am J Roentgenol. 1998 Jul;171(1):119–24.
49.Caliigaro KD. Veith F.J. Graft-preserving methods for managing aortofemoral prosthetic graft infection. Eur J Vasc Endovasc Surg.1997;14(Suppl. A):38–45.
50.Calligaro KD, Veith FJ, Yuan JG, Gargiulo NJ, Dougherty MJ. Intra-abdominal aortic graft infection: complete or partial graft preservation in patients at very high risk. J Vasc Surg. 2003 Dec;38(6):1199–205.
51.Tambyraja AL, Chalmers RT. Conservative management of MRSAperiaortic graft abscess. Ann Vase Surg. 2003;17:676–82.
52.Bandyk DF, Bergamini TM, Kinney EV, Seabrook GR, Towne JB.In situ replacement of vascular prostheses infected by bacterial biofilms. J Vasc Surg. 1991 May;13(5):575–83.
53.Becquemin JP, Qvarfordt P, Kron J, Cavillon A, Desgranges P, Allaire E, Melliere D. Aortic graft infection: is there a place for partial graft removal? Eur J Vasc Endovasc Surg. 1997 Dec;14(Suppl. A):53–58.
54.Miller JH. Partial replacement of an infected arterial graft by a new prosthetic polytetrafluoroethylene segment: a new therapeutic option. J Vasc Surg. 1993;17:546–54.
55.Towne JB, Seabrook GR, Bandyk D, Freischlag JA, Edmiston CE. In situ replacement of arterial prosthesis infected by bacterial biofilms: long-term follow-up. J Vasc Surg. 1994 Feb;19(2):226–33; discussion 233–35.
56.Sladm JG, Chen JC, Reid JDS. An aggressive local approach to vascular graft infection. Am J Surg. 1998;176:222–35.
57.Kaiser AB, Clayson KR, Mulherin JL Jr, Roach AC, Allen TR, Edwards WH, Dale WA. Antibiotic prophylaxis in vascular surgery. Ann Surg. 1978 Sep;188(3):283–89.
58.Pitt HA, Postier RG, MacGowan AW, Frank LW, Surmak AJ, Sitzman JV, Bouchier-Hayes D. Prophylactic antibiotics in vascular surgery: topical, systemic, or both? Ann Surg. 1980 Sep;192(3):356–64.
59.Hasselgren PO, Ivarsson L, Risberg B, Seeman T. Effects of prophylactic antibiotics in vascular surgery. A prospective, randomized, double-blind study. Ann Surg. 1984 Jul;200(1):86–92.
60.Hall JC, Christiansen KJ, Goodman M, Lawrence-Brown M, Prendergast FJ, Rosenberg P, Mills B, Hall JL. Duration of antimicrobial prophylaxis in vascular surgery. Am J Surg. 1998 Feb;175(2):87–90.
61.Kurz A, Sessler DL, Lenhardt R. Study of Wound infection Group. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl Med J. 2000;342:161–67.

Адрес для корреспонденции:
246000, Республика Беларусь, г. Гомель, ул. Ланге, д. 5, УО «Гомельский государственный медицинский университет», кафедра хирургических болезней №3 с курсом сердечно-сосудистой хирургии,
e-mail: Lyzikov@mail.ru,
Лызиков Алексей Анатольевич
Cведения об авторах:
Лызиков А.А., к.м.н. доцент кафедры хирургических болезней №3 с курсом сердечно-сосудистой хирургии УО «Гомельский государственный медицинский университет».
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