感染性遠位浅大腿動脈瘤に対してViabahnステントグラフト内挿術を施行した一例

antibiotics without consensus on duration or

preferred agents5)12)13). Recommendations have

1)

included starting antibiotics early and prolonged

duration of post-operative antibiotics (e. g., ＞ six

months postoperatively or lifelong)5)12)13). Most

investigators report that non-Salmonella infection

2)

is a significant risk factor for operative mortality,

however Luo et al. indicate the necessity for

lifelong oral antibiotics in patients with positive

blood cultures regardless of non-Salmonella infec-

3)

tion or Salmonella infection4).

This case had to stop taking oral antibiotics

after five months due to decreased renal function,

4)

but the patient was actually planning to take it for

lifelong. Fortunately, this case was no sign of

recurrence of the infection for two years. Careful

5)

short and long-term follow-up is required for

possibility of recurrence of infection after endovascular treatments for infected aneurysms.

Although randomized controlled trials may be

6)

the ultimate answer to the role of endovascular

stent-graft replacement in infected SFA

aneurysms, a proper number for a trial may be

impossible given with the rarity of this entity.

Case series such as this with longer term

7)

follow-up data may be useful in defining the role

of endovascular treatment in this difficult clinical

situation.

8)

Hsu RB, Chang CI, Wu IH and Lin FY : Selective

medical treatment of infected aneurysms of the

aorta in high risk patients. J Vasc Surg. 49 :

66-70, 2009.

Hsu RB, Tsay YG, Wang SS and Chu SH :

Surgical treatment for primary infected

aneurysm of the descending thoracic aorta,

abdominal aorta, and iliac arteries. J Vasc Surg.

36 : 746-750, 2002.

Yu SY, Lee CH, Hsieh HC, Chou AH and Ko PJ :

Treatment of primary infected aortic aneurysm

without aortic resection. J Vasc Surg.56 : 943950, 2012.

Luo CM, Chan CY, Chen YS, Wang SS, Chi NH

and Wu IH : Long-term Outcome of Endovascular Treatment for Mycotic Aortic Aneurysm.

Eur J Vasc Endovasc Surg. 54 : 464-471, 2017.

Sörelius K, Wanhainen A, Furebring M, Björck

M, Gillgren P and Mani K : Nationwide study of

the treatment of mycotic abdominal aortic

aneurysms comparing open and endovascular

repair. Circulation.134 : 1822-1832, 2016.

Inaraja-Pérez GC, Adoración RC, Jose-Antonio

LS, Maria-Isabel LG and Irene SV : A Bail Out

Solution for an Urgent Situation : Endovascular

Exclusion and Embolization of an Infected

Femoral pseudoaneurysm. Ann Vasc Surg. 69 :

454. e1-454. e5, 2020.

Zhang L,Bao J,Zhao Z, Lu Q,Zhou J and Jing Z :

Effectiveness of Viabahn in the treatment of

superficial femoral artery occlusive disease : a

systematic review and meta-analysis. J Endovasc Ther. 22 : 495-505, 2015.

Ohki T, Kichikawa K, Yokoi H, Uematsu M,

Yamaoka T, Maeda K and Kanaoka Y : Outcom-

Endovascular treatment for infected aneurysm

es of the Japanese multicenter Viabahn trial of

endovascular stent grafting for superficial

femoral artery lesions. J Vasc Surg. 66 : 130142, 2017.

9) Di X, Liu C, Zeng R and Ni L : Endovascular

Aortic Repair Is a Viable Strategy for Treatment of Primary Infected Abdominal Aortic

Aneurysm. Ann Vasc Surg. 63 : 117-128, 2020.

10) Shimizu R, Sumi M, Murakami Y and Ohki T :

Anatomical Reconstruction Using Femoral Vein

for the Treatment of an Infected Abdominal

Aortic Aneurysm. Jpn J Vasc Surg.29 : 319-323,

2020.

11) Kondo N, Tamura K, Sakaguchi T, Chikazawa G

and Yoshitaka H : Replacement of the Thor-

12)

13)

231

acoabdominal Aorta after Endovascular Abdominal Aneurysm Repair for Ruptured Infected

Aneurysm : A Case Report.Ann Vasc Dis. 10 :

63-65, 2017.

Kan CD, Lee HL and Yang YJ : Outcome after

endovascular stent graft treatment for mycotic

aortic aneurysm : a systematic review. J Vasc

Surg.46 : 906-912, 2007.

Zemela MS, Minami HR, Jacobs D and Smeds

MR : Repair of complex mycotic aneurysm with

multiple parallel stent grafts using an endovascular approach. Ann Vasc Surg-Brief

Reports and Innovations. 2 : 100034, 2022.

(Received for publication September 6, 2021)

232

S. Tanaka et al.

感染性遠位浅大腿動脈瘤に対して Viabahn ステントグラフト

内挿術を施行した一例

1)

小倉記念病院 血管外科

小倉記念病院 循環器内科

2)

一1)，艫

輔2)，田

潔1)，岡

仁1)

末梢動脈瘤に対するステントグラフトによる血管内治療は有効であるが，感染を伴った鼠経靭帯以

下領域の末梢動脈瘤に対する治療報告は散見されるものの長期成績を含めた有効性は確定していない．

患者は 84 歳男性．主訴は右大腿部腫脹と疼痛であり CT 検査で不整な形状をした右遠位浅大腿動脈

瘤を認めた．血液検査では高炎症反応を認め感染性動脈瘤を強く疑った．感染が制御できない場合は

bridge surgery も視野に入れて，緊急で Viabahn ステントグラフト内挿術を施行した．術後経過良好

で救肢となり，独歩で自宅退院．2 年経過してもステントグラフトは開存を維持して感染の再燃もな

く，歩行機能も維持している．

キーワード：感染性末梢動脈瘤，浅大腿動脈，ステントグラフト

...