Turkiye Klinikleri Cardiovascular Sciences

.: ORIGINAL RESEARCH
Majör Protez Vasküler Greft Enfeksiyonlarının Tedavisi ve Erken Dönem Sonuçların Değerlendirilmesi: Retrospektif Klinik Araştırma
Treatment Strategies of Major Prosthetic Vascular Graft Infections and Evaluation of Short Term Results: Retrospective Clinical Research
Veysel BAŞARa, Ekin Can ÇELİKb, Ahmet ZENGİNa, Mehmed YANARTAŞc, Mehmet Erdem TOKERa
aKartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul, TÜRKİYE
bAntalya Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, Antalya, TÜRKİYE
cBaşakşehir Çam ve Sakura Şehir Hastanesi, Kalp ve Damar Cerrahisi Kliniği, İstanbul, TÜRKİYE
Turkiye Klinikleri J Cardiovasc Sci. 2021;33(2):45-53
doi: 10.5336/cardiosci.2020-80901
Article Language: TR
Full Text
ÖZET
 Amaç: Protez vasküler greft enfeksiyonları (PVGE), tedavisinde güçlükleri olan bir patoloji olarak güncel bir alandır. PVGE'lerin klinik süreci fazlaca değişiklik göstermektedir. Bu durum, hastalığın yönetiminde rehberlik edebilecek bir kılavuzun hazırlanmasını güçleştirmektedir. Çalışmamızda, hastanemizde tedavi ettiğimiz 23 majör PVGE olgusunun seyrini, sonuçlarını paylaştık. Gereç ve Yöntemler: 2011-2018 yılları arasında periferik arter hastalığı nedeniyle ameliyat edilmiş 336 hastanın verileri taranarak, 23 majör PVGE hastası tespit edildi. Verileri retrospektif olarak toplandı. Demografik özellikler, eşlik eden patolojiler ve advers olaylar literatür örneklerine göre çalışmaya dâhil edildi. PVGE'nin lokasyonuna ve Samson sınıflamasına göre alt gruplar oluşturuldu. Hastalara greft koruyucu cerrahi yöntemleri veya total enfekte greft eksizyonu ameliyatları uygulandı. Erken dönem tekrarlayan enfeksiyon, tromboz ve kanamaya bağlı ikincil arteriyel operasyon, amputasyon, uzamış hastane yatışı ve mortalite incelediğimiz erken dönem postoperatif parametrelerdi. Bulgular: Samson sınıflandırmasına göre 5 hasta (%21,7) sınıf III, 9 hasta (%39,1) sınıf IV ve 9 hasta (%39,1) sınıf V alt gruplarına ayrıldı. PVGE'lerin 7 tanesi intrakaviter (%30,4) ve 16 tanesi periferik (%69,6) yerleşimliydi. Preoperatif dönemde perigreft hematom bulunan hastaların postoperatif dönemde daha çok revizyona alındığı tespit edildi. Dacron greft materyali kullanılan hastalarda anlamlı C-reaktif protein yüksekliği görüldü. Hastane içi mortalite oranı 4 hasta ile %17,4 idi. Sonuç: PVGE, mortalite ve morbiditesi yüksek bir klinik tablo olup, tanı ve tedavi süreçlerinin yürütülmesine yönelik multidisipliner yaklaşım önemlidir. PVGE'ler amputasyon ve sepsis açısından yakın izlem, erken müdahale önem arz etmektedir. Çalışmalarla ortaya konulabilecek bir kılavuza ihtiyaç duyulmaktadır. Sentetik greft kullanırken en üst düzey cerrahi özen gösterilmesi, sterilite şartlarına azami dikkat edilmesi gerekmektedir.

Anahtar Kelimeler: Damar greftleme; vasküler protez; protez kaynaklı enfeksiyonlar; hematom; biyouyumlu materyaller
ABSTRACT
 Objective: Prosthetic vascular graft infections (PVGI) are up-to-date pathologies with challenging and various treatment strategies. In the account of PVGI; there are so many protocols considering diagnosis and treatment with the lack of evidence and proper guideline recommendation. In this study, we evaluated clinical manifestations and treatment outcomes of twenty-three patients with major PVGI. Material and Methods: We retrospectively collected the data of twenty-three patients with major PVGI among three hundred thirty-six patients who have surgically treated for peripheral artery diseases between 2011 and 2018. Demographical parameters, co-existing pathologies, and adverse events were included in our study according to current literature examples. Subgroups were formed by the location of PVGI and the Samson classification. Patients underwent either graft sparing or total graft excision surgical procedures. Early postoperative infection, additional arterial intervention, amputation, prolonged in-hospital stay, and mortality were recognized as adverse events. Results: Five patients were Class III (21.7%), nine patients were Class IV (39.1%) and nine patients were Class V (39.1%) of the Samson classification system. The number of patients with intra-cavitary PVGI is seven (30.4%), peripheral PVGI is sixteen (69.6%). We have found that the existence of perigraft hematoma is related to higher rates of postoperative vascular intervention. C-reactive protein levels are significantly higher in patients with previously implanted Dacron graft. The in-hospital rate of mortality is 17.4%. Conclusion: Multidisciplinary effort to publish a guideline to manage the overall process of PVGI is needed. Close follow-up and early intervention are vital. Top surgical performance should be performed with care and sterility protocols should be applied at maximum.

Keywords: Vascular grafting; vascular prosthesis; prosthesis-related infections; hematoma; biocompatible materials
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