mossjМосковский хирургический журналMoscow Surgical Journal2072-3180ООО «ПРОФИЛЬ – 2С»10.17238/2072-3180-2026-111-117mossj-1292Research ArticleЛИТЕРАТУРНЫЕ ОБЗОРЫLITERARY REVIEWSИнфицирование сосудистых протезов после инфраингвинальных реконструкций – современное состояние проблемы и пути решенияInfection of vascular grafts after infrainguinal reconstructions – the current state of the problem and possible solutions.https://orcid.org/0000-0003-3961-5670ГубаревИ. А.GubarevI. A.

Губарев Игорь Александрович – кандидат медицинских наук, руководитель службы экстренной сосудистой хирургии

119049, Россия, Москва, Ленинский проспект, д. 8

Gubarev Igor Alexandrovich – Cand. Sci. (Med.), vascular surgeon; Chief of vascular surgery service

119049, Leninsky Prospekt, 8, Moscow, Russia

angiodoc@mail.ruhttps://orcid.org/0000-0001-5366-1281ЛебедевС. С.LebedevS. S.

Лебедев Сергей Сергеевич – доктор медицинских наук, доцент кафедры хирургии; главный врач

119049, Россия, Москва, Ленинский проспект, д. 8

Lebedev Sergey Sergeevich – Doctor of Medical Sciences, Associate Professor of the Department of Surgery of the Russian Academy of Medical Sciences, Chief Physician

119049, Leninsky Prospekt, house 8, Moscow, Russia

lebedevssd@yandex.ruhttps://orcid.org/0000-0002-4112-7732МатюшкинА. В.MatyushkinA. V.

Матюшкин Андрей Валерьевич – доктор медицинских наук, профессор, врач сердечно-сосудистый хирург службы экстренной сосудистой хирургии; профессор кафедры факультетской хирургии № 1 ИХ 

119049, Россия, Москва, Ленинский проспект, д. 8

117513, Россия, Москва,. ул. Островитянова д. 1

Matyushkin Andrew Valerevich – Dr. Sci. (Med.), professor, vascular surgeon; vascular surgery service; professor

119049, Leninsky Prospekt, 8, Moscow, Russia

117513, Ostrovityanova Street, 1, Moscow, Russia

matyushkinav1@zdrav.mos.ruhttps://orcid.org/0009-0000-2539-1974АнЕ. С.AnE. S.

Ан Евгений Санхович – кандидат медицинских наук, заместитель главного врача по хирургии

119049, Россия, Москва, Ленинский проспект, д. 8  

An Evgeny Sankhovich – Candidate of Medical Sciences, Deputy Chief Physician for Surgery at the State Budgetary Healthcare Institution

119049, Leninsky Prospekt, house 8, Moscow, Russia

AnES@zdrav.mos.ruГБУЗ г. Москвы «Городская клиническая больница № 1 им. Н.И. Пирогова»РоссияCity Clinical Hospital no 1 named after N.I. Pirogov, Moscow City Health DepartmentRussian FederationГБУЗ г. Москвы «Городская клиническая больница № 1 им. Н.И. Пирогова»; ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РФРоссияCity Clinical Hospital no 1 named after N.I. Pirogov, Moscow City Health Department; Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian FederationRussian FederationГБУЗ г. Москвы «Городская клиническая больница № 1 им. Н.И. Пирогова»; ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова»РоссияCity Clinical Hospital no 1 named after N.I. Pirogov, Moscow City Health Department; Pirogov Russian National Research Medical UniversityRussian Federation20261710202605Октябрь. Спецвыпуск111117Copyright © Губарев И.А., Лебедев С.С., Матюшкин А.В., Ан Е.С., 20262026Губарев И.А., Лебедев С.С., Матюшкин А.В., Ан Е.С.Gubarev I.A., Lebedev S.S., Matyushkin A.V., An E.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.mossj.ru/jour/article/view/1292

Введение. Несвоевременно распознанная инфекция сосудистого протеза может привести к катастрофическим последствиям – сепсису, тромбозу, несостоятельности трансплантата с развитием массивного кровотечения.Основная часть. Консервативная терапия инфекций сосудистых трансплантатов без удаления инфицированного кондуита признана неэффективной по причине высокой смертности пациентов (до 45 %) в сроки наблюдения до 5 лет, стойкой инфекции, высоких рисков несостоятельности анастомозов с развитием аррозивных кровотечений. VAC-терапия является эффективной терапией в лечении инфекций и направлена на ускоренное заживление инфицированных ран методом отрицательного давления, однако на сегодняшний день данную методику можно расценивать как экспериментальную, так как количество исследований на тему эффективности применения VAC-терапии при инфекции сосудистых трансплантатов крайне ограничено и основано на небольших выборках больных. Активное дренирование и промывание инфицированных ран может применяться в лечении инфекции сосудистых протезов с целью снижения бактериальной колонизации инфицированных тканей, однако, данный метод в качестве монотерапии может применяться лишь у пациентов, которым невозможно удалить инфицированный трансплантат.Заключение. Ключом к успешному лечению является точная идентификация инфицирующего агента, назначение специфической антибактериальной терапии, правильно спланированное хирургическое вмешательство. Метод лечения инфекции сосудистого протеза должен подбираться индивидуально, с учетом выраженности и локализации инфекционного процесса, характера ишемии конечности, наличия аутологичной вены либо альтернативных трансплантатов, опыта хирургической бригады и оснащенности клиники.

Introduction. Untimely recognition of an infection in a vascular prosthesis can lead to catastrophic consequences - sepsis, thrombosis, and graft failure with the development of massive bleeding.The main part. Conservative therapy for infections of vascular grafts without removing the infected conduit has been proven ineffective due to the high mortality rate of patients (up to 45 %) within a follow-up period of up to 5 years, persistent infection, and high risks of anastomotic failure with the development of erosive bleeding. VAC therapy is an effective treatment for infections and is aimed at accelerating the healing of infected wounds using negative pressure. However, at present, this technique can be considered experimental, as the number of studies on the effectiveness of VAC therapy in treating infections of vascular grafts is extremely limited and is based on small patient samples. Active drainage and irrigation of infected wounds can be used in the treatment of vascular graft infections to reduce bacterial colonization of infected tissues; however, this method can be used as monotherapy only in patients in whom it is impossible to remove the infected graft.Conclusion. The key to successful treatment is the accurate identification of the infecting agent, the prescription of specific antibacterial therapy, and properly planned surgical intervention. The method of treating vascular prosthesis infection should be selected individually, taking into account the severity and localization of the infectious process, the nature of limb ischemia, the presence of an autologous vein or alternative grafts, the experience of the surgical team, and the clinic’s equipment.

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The authors declare that there are no conflicts of interest present.