Mykotische Aneurysmen

Zusammenfassung

12 Patienten mit mykotischen Aneurysmen (7 mit Aneurysmen im aorto-iliacalen Bereich, 5 mit peripheren bzw. viszeralen Aneurysmen) wurden in einem Zeitraum von 6 Jahren behandelt und retrospektiv analysiert. Es handelte sich um 10 männliche und 2 weibliche Patienten mit einem Durchschnittsalter von 53 Jahren. 2 Patienten hatten multiple Aneurysmen. Ein Erregernachweis konnte in 2/3 der Fälle geführt werden, wobei in über 80 % Staphylokokken und Salmonellen nachweisbar waren. Beim Befall peripherer Arterien ist häufig ein pulsatiler Tumor tastbar, welcher sich in relativ kurzer Zeit entwickelt hat und gegebenenfalls eine floride perivaskuläre Entzündung aufweist. Dagegen ist dies nur selten der Fall, wenn zentrale Arterien betroffen sind. Anamnestisch lässt sich häufig ein septisches Geschehen oder eine Infektion wie z. B. eine Salmonellenenteritis eruieren, die der Entwicklung des mykotischen Aneurysma unmittelbar vorausgehen. Bei Aneurysmen zentraler Gefäßabschnitte (6 Patienten) halten wir die in situ-Gefäßrekonstruktion mit alloplastischem Material in Kombination mit dem perivaskulären Debridement, Lavage und Netzmanschette für die Behandlung der Wahl. In der Peripherie sollte die Rekonstruktion mit autologem Gefäßersatzmaterial erfolgen, wobei auch hier entsprechend dem Lokalbefund ein perivaskuläres Debridement ausgeführt werden sollte. In jedem Fall ist die Rekonstruktion mit einer kalkulierten Antibiotikatherapie zu kombinieren. Zwei Patienten sind perioperativ verstorben, die Rekonstruktionen bei 8 nachuntersuchten Patienten sind offen und ohne Infektionszeichen. Die Dringlichkeit der Operation richtet sich nach der Floridität des Entzündungsprozesses und dem Vorhandensein von Sekundärkomplikationen.

Summary

12 patients (10 males and 2 females, average age 53 years) were operated upon in our hospital between 1994 and 1999 for mycotic aneurysms. The aneurysms were located in 7 patients in the aorto-iliac segment, 5 patients were treated for peripheral or visceral aneurysms. Two of these patients suffered from multiple aneurysms. When peripheral arteries were affected, a pulsatile tumour was felt. Most of these tumours developed in a relatively short period of time and sometimes a perivascular inflammation occurred. This was not the case when central arteries were attacked. A septic process or an infection, for example salmonella-enteritis, often preceded shortly the development of a mycotic aneurysm. In the case of an aneurysm of the aorto-iliac section we consider an in situ reconstruction with alloplastic material in combination with a perivascular debridement, lavage and omentum majus plastic as the treatment of choice. In peripheral arteries reconstruction should be performed with autologous vessels. Depending on the local findings, a perivascular debridement should also be performed in these cases. The reconstruction always should be combined with a calculated antibiotic therapy. Two of our patients died perioperatively. During follow up, 8 patients showed patent reconstructions and no signs of infection. The urgency of surgery depends on the level of inflammation and the existence of any secondary complications.

Mykotische Aneurysmen - Analyse

Mycotic aneurysms - Analysis

Literatur

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