关键词: 感染性腹主动脉瘤, 自体股浅静脉, 主髂动脉系统重建, 自体静脉重建主髂动脉系统手术, 感染负荷, 抗生素治疗, 血流重建, 远期预后

Abstract: To evaluate the safety and efficacy of neo-aortoiliac system (NAIS) reconstruction using an autologous superficial femoral vein in the treatment of infectious abdominal aortic aneurysm (IAAA). Methods    A retrospective analysis was conducted on the clinical data of 12 patients with IAAA who underwent NAIS surgery at Zhongshan Hospital, Fudan University, from 2022 to 2024. The analysis included preoperative diagnosis, intraoperative management, and postoperative care. All patients met the diagnostic criteria for IAAA, and intraoperative pathogen identification combined with susceptibility testing was performed to guide individualized antibiotic regimens. Follow-up assessments evaluated surgical outcomes and long-term prognosis. Results    Among the 12 patients, 11 had confirmed pathogen diagnoses, including 7 with multidrug-resistant organisms. All patients successfully underwent surgery. One patient died on postoperative day 10 due to anastomotic rupture, while the remaining 11 survived until the end of the follow-up period. The average ICU stay was 6.2 days, and the mean total hospital stay was 23 days. The duration of antibiotic therapy ranged from 2 to 37 weeks, with an average of 17.2 weeks. The mean follow-up duration was 64.9 weeks (13-130 weeks). Among the 11 surviving patients, 10 were free from antibiotic dependency without infection recurrence, while one still required long-term oral antibiotic therapy as of November 2024. No cases of compartment syndrome or post-thrombotic syndrome were reported, although 5 patients complained of venous insufficiency symptoms. CT imaging follow-up revealed no graft-related aneurysmal changes. Conclusion    NAIS surgery offers an effective strategy for in situ revascularization in IAAA, particularly for patients with high infection burdens, multidrug-resistant organisms, or poor responses to antibiotic therapy. Despite the extensive surgical trauma, antibiotic dependency was significantly reduced, and long-term outcomes were favorable. NAIS surgery can be considered one of the preferred treatment options for severe IAAA after a comprehensive evaluation of patient fitness and infection complexity.

Key words: infectious abdominal aortic aneurysm, autologous superficial femoral vein, neo-aortoiliac system reconstruction, NAIS surgery, infection burden, antibiotic therapy, vascular reconstruction, long-term outcomes