, 58 years old, was diagnosed with threatened rupture of infectious abdominal aortic aneurysm in January this year. covered stent. However, postoperative antibiotic treatment was ineffective, and the infection progressed rapidly in a short period of time, resulting in severe infection of the stent and retroperitoneum, and the risk of tumor rupture and bleeding at any time. The patient has not been admitted and effectively treated in many places. Finally came to Shanghai Zhongshan Hospital Vascular Surgery for treatment. At the time of diagnosis, the patient was in a state of extremely severe infection, bacteremia, incomplete intestinal obstruction, severe malnutrition, and cachexia, and septic shock may occur at any time. </span></p><p><span>The treatment dilemma of this disease is that the artificial blood vessels or covered stents currently used for the treatment of general abdominal aortic aneurysms cannot reliably treat infected abdominal aortic aneurysms. . Since antibiotics do not work on these artificial materials, these artificial grafts are bound to be reinfected after catheterization of infected abdominal aortic aneurysms. However, due to the important role and anatomical characteristics of the abdominal aorta, artificial grafts are still used as the main method for the treatment of the disease at home and abroad. Most patients still face a recurrence of the infection eventually, and the survival rate is extremely low. </span></p><p><span>Professor Fu Weiguo’s team quickly completed the examination and preoperative planning after the patient was admitted. It is determined that the infection of the retroperitoneal abdominal aorta is serious, and the original implanted stent must be removed, but artificial blood vessels cannot be used to replace the original infection area; at the same time, because the patient has bacteremia, it is not suitable to use “axillary-femoral bypass surgery” ” to rebuild the blood supply to the lower extremities, because the bacteria in the blood will also contaminate the bypass graft; furthermore, due to the patient’s severe malnutrition, the risk of poor postoperative incision healing is high, once the “axillary-femoral” graft is exposed. catastrophic result. </span></p><div class=)
Is Mr. Li really hopeless? Director Fu Weiguo knew that there might be a way to go, but it was extremely difficult for both the surgeon and the patient, that is to use the deep veins of the lower extremities to “spliced blood vessels” to reconstruct the abdominal aorta. However, due to the complicated technique, large trauma and difficult postoperative management, there is no domestic precedent for this operation, and only a few vascular surgery centers have reported it abroad. The patient is at stake, the risk of septic shock is high, and there is not much time left for the surgical team. Therefore, Yue Jianing, the attending physician in the vascular surgery team, reviewed the few foreign literature reports, and made full use of the surgical experience of “transposition of the superficial femoral vein to establish lower extremity dialysis vascular access”, which was also the “first case in the country”. preoperative preparation and surgical planning.
On the third day after admission, the patient underwent this groundbreaking procedure. The patient was found to have an abdominal aorto-colonic fistula, the most serious and lethal rare condition of an infected abdominal aortic aneurysm. Under the full evaluation and guidance of Director Fu Weiguo, Deputy Chief Physician Yang Jue and Chief Physician Yue Jianing completed the operation together. During the operation, Tong Hanxing, deputy chief physician of the general surgery department, provided assistance to complete the resection of the retroperitoneal infection. The vascular surgery team first removed the original stent, took the superficial femoral veins of the bilateral thighs, and spliced them into a “herringbone” shape suitable for the caliber of the abdominal aorta. Autologous vascular graft, reconstruction of the patient’s abdominal aorta.
Due to the presence of infection, the autologous blood transfusion device cannot be used during the operation, which is a great challenge to the control of intraoperative bleeding and anesthesia management. Control the patient’s anesthesia management, precisely control the patient’s vital signs, and ensure a smooth operation. In the end, with the intensive cooperation of the vascular surgery, general surgery, anesthesiology, and surgical nursing teams, the operation time was 9 hours, and the operation was completed as planned. After the operation, the patient entered the intensive care unit, and under the management of the attending physician Zheng Yijun, the patient survived the postoperative risks such as severe anemia, severe nutritional disorder, abdominal infection, hemorrhage, respiratory failure, and renal insufficiency. The patient did not suffer from possible serious complications such as venous graft rupture and bleeding, lower extremity compartment syndrome, and lower extremity deep vein thrombosis.
This is the first case of abdominal aortic aneurysm with autologous deep vein reconstruction in my country for the treatment of severe infectious abdominal aortic aneurysm. “The exploration of the surgical plan has rewritten the status quo that the disease has been in “palliative” treatment in my country.
Xinmin Evening News reporter Zuo Yan