감염성 심내막염을 합병한 대동맥-대퇴동맥 간 우회로 인조혈관 감염 1예
A Case of Aorto-femoral bypass Graft Infection Complicated with Infective Endocarditis
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본 증례는 복부 대동맥류와 양 장골동맥 폐색증으로 대동맥-양대퇴동맥 간 우회로 인조혈관 이식술을 시행했던 환자에서 술 후 이식편 감염과 심내막염이 발병한 예이다. 환자는 이식편 감염의 진단이 모호할 때 Tc-99m HMPAO 백혈구 스캔을 통해 감염을 확인하고, 재수술을 시행하여 특별한 합병증 없이 회복하여 퇴원하였다.이식편 감염의 진단에 있어서 대개는 일반적인 창상 감염에서 볼 수 있는 발열, 백혈구 증다증, 수술부위의 농양, 화농성 분비물 등을 통해 진단한다. 또한 영상학적 검사로 컴퓨터 단층촬영, 자기공명영상 등의 검사를 통해 이식편 감염을 진단하기도 한다. 하지만 술 후 초기 내지 저독성의 감염인 경우 그리고 진단이 모호한 경우에는 백혈구 스캔을 통해 신속히 이식편 감염을 더 잘 진단할 수도 있어 국내에서 이식편 감염 진단방법으로써 백혈구 스캔의 더 많은 활용과 연구가 요구된다.
Abstract
Prosthetic vascular graft infection (PVGI) is a relatively uncommon complication of peripheral vascular surgery and although rare, is the most severe complication in reconstructive vascular surgery. The early diagnosis of this complication can reduce the mortality. We report a case of aorto-femoral bypass graft infection, which was diagnosed by Tc-99m HMPAO WBC scan, complicated with infective endocarditis. A 60-year-old man had been operated with aortofemoral bypass graft because of aortojejunal fistula due to abdominal aortic aneurysm. Nine months later, he was admitted with fever of two months' duration. On echocardiolography, aortic regurgitation and vegetation were observed, and then he was diagosed with infective endocarditis. He was treated with antibiotics for 6 weeks. Recurrent bacteremia of unknown origin persisted despite antibiotic therapy. Multiple microorganisms were separately isolated from the blood cultures. He complained of intermittent right groin pain. Imaging study (CT, MRI, US) showed no definite evidence of graft infection. However, Tc-99m HMPAO WBC scan demonstrated uptake in the aortofemoral bypass graft site. The patient underwent emergent aortofemoral graft removal with axillobifemoral bypass and right femoropopliteal bypass.
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