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.
Schlüsselwörter
Mykotische Aneurysmen - Analyse
Key words
Mycotic aneurysms - Analysis
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Dr. F. Klein
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