覆膜支架植入抢救艾滋病患者注射毒品所致感染性假性动脉瘤大出血

Covered stent implantation for the rescue of femoral infectious pseudoaneurysm hemorrhage caused by drug injection in AIDS patients

目的 探讨覆膜支架植入抢救艾滋病患者注射毒品所致感染性假性动脉瘤大出血的效果及安全性。方法 抢救治疗艾滋病患者注射毒品所致感染性假性动脉瘤大出血21例,先行覆膜支架植入术封闭破口、隔绝假性动脉瘤和感染灶,生命体征平稳后作外科手术清创治疗。结果 所有患者植入1枚覆膜支架均一次成功,术后患肢缺血情况改善,外科清创手术全部完成。支架植入术后72 h内清创20例,控制感染并完全康复出院;48 h内清创1例,术中发生大出血,感染未能有效控制,1个月后死于多脏器衰竭。术后随访0.5-4年,20例患者未出现手术相关并发症,患肢功能正常。结论 覆膜支架植入治疗艾滋病患者注射毒品所致股动脉感染性假性动脉瘤大出血,创伤小,随访期无相关并发症,为病灶清创修复创造条件,是一种安全有效的抢救生命措施。

Objective To discuss the feasibility and safety of covered stent implantation for the rescue of femoral infectious pseudoaneurysm hemorrhage caused by drug injection in patients with acquired immune deficiency syndrome （AIDS）. Methods Rescue efforts were carried out for 21 AIDS patients with femoral infectious pseudoaneurysm hemorrhage caused by drug injection. First, covered stent implantation was performed to close the rupture and to isolate the pseudoaneurysm as well as the focal infection, then the surgical debridement treatment was conducted when the vital signs became stable. Results Implantation of one covered stent with single procedure was successfully accomplished in all patients. After the treatment the ischemic condition of the sick lower limb was improved, and the surgical debridement treatment was thoroughly completed. In 20 patients the surgical debridement treatment was employed within 72 hours after stent implantation, the infection was controlled, and the patients completely recovered at the time of discharge. One patient underwent surgical debridement treatment within 48 hours after stent implantation, and massive bleeding occurred during the operation, the infection could not be effectively controlled, and one month later the patient died of multiple organ failure. The patients were followed up for 0.5-4 years, no procedure-related complications occurred, and the function of diseased lower limbs were normal. Conclusion For the treatment of femoral infectious pseudofaneurysm hemorrhage caused by drug injection in AIDS patients, covered stent implantation is safe and minimally-invasive with no procedure-related complications in follow-up period, it provides favorable conditions for the performance of surgical debridement and repair of the lesion, therefore,