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Zeng Y, Yuan P, He Q. Comparison between covered-stents grafting and ligation in the treatment of infected femoral pseudoaneurysm due to intravenous drug abuse. Vascular 2024:17085381241240237. [PMID: 38490959 DOI: 10.1177/17085381241240237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Abstract
OBJECTIVES The study compared the outcomes between covered-stents grafting (CSG) and ligation of femoral artery (LFA) in the treatment of infected femoral pseudoaneurysm (IFP) caused by intravenous drug injection. METHODS From 1st January 2016 to 30th November 2021, the clinical data of patients with IFP caused by intravenous drug injection who underwent CSG (n = 31, 55.4%) and LFA (n = 25, 45.4%) are retrospectively analyzed. We compared the baseline characteristics and clinical outcomes of the two groups, including early and late mortality and morbidity. RESULTS A total of 56 patients were enrolled in the study, comprising 50 (89.3%) men and 6 (10.7%) women, with a mean age of 34.3 years. There was no significant difference observed between the two groups in terms of 30-day mortality (3.2% vs 0%, p = .365) and length of stay (9 [7, 12] vs 11 [8.5, 12.5] days, p = .236). However, group CSG exhibited a lower rate of intermittent claudication (0% vs 32%, p = .001), less blood loss (67.1 ± 22.5 mL vs 177.0 ± 59.8 mL, p < .001), and shorter surgery duration (57.5 ± 9.9 min vs 84.4 ± 22.8 min, p < .001) compared to group LFA. The LFA group were divided into subgroups according to the ligation site. The amputation rate of superficial femoral artery ligation group (0 vs 27.3%, p = .014) was significantly lower than common femoral artery ligation. CONCLUSIONS Covered-stents grafting may be a preferable treatment to LFA for IFP due to intravenous drug abuse, particularly when the entry tear is located in the common femoral artery.
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Affiliation(s)
- Yanzhang Zeng
- Department of Vascular and Thyroid Surgery, Guizhou Provincial People's Hospital, Guiyang, China
| | - Ping Yuan
- Department of Vascular and Thyroid Surgery, Guizhou Provincial People's Hospital, Guiyang, China
| | - Qiang He
- Department of Intervention, Guizhou Provincial People's Hospital, Guiyang, China
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2
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MacLeod CS, Radley A, Strachan D, Khan F, Nagy J, Suttie S. Management of the infected arterial pseudoaneurysm secondary to groin injecting drug use and outcomes: a systematic review protocol. BMJ Open 2023; 13:e070615. [PMID: 37321813 PMCID: PMC10277064 DOI: 10.1136/bmjopen-2022-070615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
INTRODUCTION People who inject drugs are at risk of a range of injecting-related infections and injuries, which can threaten life and limb. In parallel to escalating rates of drug-related deaths seen in Scotland and the UK, there has also been an increase in hospital admissions for skin and soft tissue infections related to injecting drug use. One such injecting complication is the infected arterial pseudoaneurysm, which risks rupture and life-threatening haemorrhage. Surgical management options for the infected arterial pseudoaneurysm secondary to groin injecting drug use remain contentious, with some advocates for ligation and debridement alone, whilst others promote acute arterial reconstruction (suture or patch repair, bypass or, more recently, endovascular stent-graft placement). Rates of major lower limb amputations related to surgical management for this pathology vary in the literature. This review aims to evaluate the outcomes of arterial ligation alone compared with arterial reconstruction, including open and endovascular options, for the infected arterial pseudoaneurysm secondary to groin injecting drug use. METHODS AND ANALYSIS The methods will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Three electronic databases will be searched and the resultant papers screened according to the study inclusion and exclusion criteria (detailed in the Population, Intervention, Comparison, Outcomes and Study design statement). Grey literature will be excluded. All papers at each stage will be screened by two independent authors, with disagreements arbitrated by a third. Papers will be subject to appropriate standardised quality assessments. PRIMARY OUTCOME Major lower limb amputation. SECONDARY OUTCOMES Reintervention rate, rebleeding rate, development of chronic limb-threatening ischaemia 30-day mortality and claudication. ETHICS AND DISSEMINATION This is a systematic review based on previously conducted studies, therefore, no ethical approval is required. The results of this work will be published in a peer-reviewed journal and presented at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42022358209.
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Affiliation(s)
- Caitlin Sara MacLeod
- Department of Vascular Surgery, NHS Tayside, Dundee, UK
- School of Medicine, University of Dundee, Dundee, UK
| | - Andrew Radley
- School of Medicine, University of Dundee, Dundee, UK
- Public Health Directorate, NHS Tayside, Dundee, UK
| | | | - Faisel Khan
- School of Medicine, University of Dundee, Dundee, UK
| | - John Nagy
- Department of Vascular Surgery, NHS Tayside, Dundee, UK
| | - Stuart Suttie
- Department of Vascular Surgery, NHS Tayside, Dundee, UK
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Zhang M, Zhang H, Tang B, Fu J, Yan H, Luo H. Outcomes of Covered Stents With Vacuum Sealing Drainage For Treatment of Infected Femoral Pseudoaneurysms in Intravenous Drug Addicts. Ann Vasc Surg 2021; 81:300-307. [PMID: 34780965 DOI: 10.1016/j.avsg.2021.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/05/2021] [Accepted: 09/11/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE For treatment of infected femoral artery pseudoaneurysms (IFAPs) with the covered stent, debridement technique is important but frequently ignored. Our study aims to review our experience and outcomes of patients undergoing covered stents placement and debridement with vacuum sealing drainage (VSD). METHODS This study retrospectively analyzed 41 intravenous drug addicts with IFAP who received covered stent implantation and debridement with VSD from January 2015 to December 2020. The diagnosis was based on the previous history of local injection and the presence of pulsatile mass at the injection site. All cases were confirmed by CT angiography (CTA), ultrasound, or digital subtraction angiography (DSA). Technical success, time of wound care, and clinical outcomes were evaluated. RESULTS Technical success was achieved in all patients. The interval from diagnosis to treatment was 26 ± 11 hours. The time of continuous drainage with VSD was 18.79 ± 6.56 days. 38 patients (92.68%) with fresh granulation tissue were sutured and discharged from the hospital. Stents in 31(91.18%) of 34 cases were patent during follow-ups. Three patients had stent occlusion caused by thrombosis, and two of them were complicated with stent infection. The two infectious stents were removed and the femoral arteries were ligated. One of them received open-surgical reconstruction with the great saphenous because of claudication. Two patients were admitted to the hospital for rebleeding caused by drug abuse relapse. CONCLUSIONS Covered stents placement is convenient and rapid to control massive hemorrhage in IFAPs of intravenous drug abuse. Early debridement of infected tissue with continued VSD may shorten the time of wound care and make the incidence of stent infection relatively low. Meanwhile, the patency in a short time follow-up is acceptable. These results indicate that covered stents implantation with VSD may be a safe, effective, and feasible measure for the treatment of IFAPs.
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Affiliation(s)
- Mingyi Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haolong Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Tang
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Fu
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiyan Yan
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hailong Luo
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Singh AA, Ashcroft J, Stather PW. Ligation Alone Versus Immediate Revascularization for Femoral Artery Pseudoaneurysms Secondary to Intravascular Drug Use: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2020; 73:473-481. [PMID: 33383134 DOI: 10.1016/j.avsg.2020.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/22/2020] [Accepted: 11/25/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Femoral artery pseudoaneurysms (FA-PSAs) remain a common vascular aneurysmal pathology associated with intravascular drug use (IVDU). To date no internationally agreed consensus regarding optimal surgical management of FA-PSAs exists. The aim of this systematic review and meta-analysis was to determine the optimal surgical treatment of FA-PSAs associated with IVDU. METHODS A systematic search was undertaken following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines identifying original studies reporting outcomes of ligation-debridement and/or excision-revascularization of FA-PSAs secondary to IVDU. Outcomes of interest were 30-day mortality, incidence of amputation at 12 months, chronic limb threatening ischemia (CLTI) at any follow-up appointment, reintervention, and bleeding. RESULTS A total of 39 cohort studies describing 1,217 FA-PSA operative outcomes met inclusion criteria, 993 (81.6%) treated by ligation-debridement and 224 (18.4%) by excision-revascularization. The incidence of 30-day mortality was 0.8% (n = 8) and 1.3% (n = 3) in the ligation-debridement and excision-revascularization groups, respectively, with only one study reporting mortality in both groups. This meta-analysis found no difference in amputation (8.89% vs. 8.03%, odds ratio (OR) 0.74 95% confidence interval (CI) 0.35-1.56, P = 0.42, 11 studies) or CLTI (21.5% vs. 12.4%, OR 1.24 95% CI 0.35-4.38, P = 0.74, 9 studies) after ligation and debridement compared with excision and revascularization. There was a higher incidence of reintervention (24.7% vs. 10.6%, OR 0.31 [95% CI 0.16, 0.62], P = 0.0009, 13 studies) and rebleeding (7.1% vs. 1.6%, OR 0.61 [95% CI 0.16, 2.38], P = 0.48, 5 studies) after excision and revascularization compared with ligation alone. CONCLUSIONS For treatments of IVDU-related FA-PSAs, this study suggests no significant difference in association of mortality, incidence of amputation, or CLTI with ligation-debridement or excision-revascularization, but a significantly higher reintervention rate and greater rebleeding rate for revascularized patients.
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Affiliation(s)
- Aminder A Singh
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Surgery, University of Cambridge, Cambridge, UK.
| | - James Ashcroft
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Surgery, University of Cambridge, Cambridge, UK
| | - Philip W Stather
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Comment on 'In situ Reconstruction of Infected Groin Pseudoaneurysm in Drug Abusers with Biological Grafts'. Eur J Vasc Endovasc Surg 2020; 60:319-320. [PMID: 32624388 DOI: 10.1016/j.ejvs.2020.05.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/21/2022]
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6
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Tresson P, Huvelle U. Re "In situ Reconstruction of Infected Groin Pseudo-aneurysm in Drug Abusers With Biological Grafts". Eur J Vasc Endovasc Surg 2020; 60:319. [PMID: 32522496 DOI: 10.1016/j.ejvs.2020.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Philippe Tresson
- Department of Vascular and Endovascular Surgery, Hopital Louis Pradel, Bron Cedex, France.
| | - Ugo Huvelle
- Department of Vascular and Endovascular Surgery, Hopital Louis Pradel, Bron Cedex, France
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7
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Ilic A, Stevanovic K, Pejkic S, Markovic M, Dimic A, Sladojevic M, Davidovic L. Vascular Injuries in Intravenous Drug Addicts-A Single-Center Experience. Ann Vasc Surg 2020; 67:185-191. [PMID: 32335251 DOI: 10.1016/j.avsg.2020.02.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Infected false aneurysms (IFA) caused by intravenous drug abuse are uncommon but challenging lesions. The best approach for the surgical management of this condition is still unknown. The aim is to present a single-center 14-year experience in the IFA treatment in intravenous drug abusers, thus providing additional data regarding the treatment options and outcome in these patients. METHODS A retrospective analysis of 32 consecutive patients with vascular injuries secondary to intravenous drug abuse, during the period from January 2004 to April 2018, was performed. Data of interest were extracted from patients' medical history records, anesthesia charts, and database implemented in daily practice, or were obtained by personal contact. The diagnosis was set based on history, physical examination and/or color Doppler sonography, multidetector computed tomographic angiography, and digital subtraction angiography. The outcome included graft patency, limb amputation, and mortality. RESULTS During study period, 32 heroin abusers, predominantly males (81%), were surgically treated due to vascular injuries, with mean age of 35.2 years. The vast majority of patients have had an injury of the lower extremity blood vessels (84.3%) and the common femoral artery was the most common site of injury (59.4%). Three-quarters of patients underwent resection of the false aneurysm and ligation of the artery without reconstruction of the blood vessel. In 7 cases (21.9%), arterial reconstruction was performed with overall failure rate of 42.86%. The overall mortality rate was 6.25% and the rate of extremity salvage was 96.7%. CONCLUSIONS The best treatment option is yet to be found, but based on the results of the present study, ligation of affected artery without revascularization seems to be an efficient, safe, and optimal treatment method, with minor risk of the extremity loss.
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MESH Headings
- Adult
- Amputation, Surgical
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/microbiology
- Aneurysm, False/mortality
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/mortality
- Aneurysm, Infected/surgery
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation/adverse effects
- Blood Vessel Prosthesis Implantation/instrumentation
- Blood Vessel Prosthesis Implantation/mortality
- Drug Users
- Female
- Heroin Dependence/complications
- Heroin Dependence/diagnosis
- Heroin Dependence/mortality
- Humans
- Ligation
- Limb Salvage
- Male
- Middle Aged
- Retrospective Studies
- Risk Factors
- Substance Abuse, Intravenous/complications
- Substance Abuse, Intravenous/diagnosis
- Substance Abuse, Intravenous/mortality
- Time Factors
- Treatment Outcome
- Vascular Patency
- Vascular System Injuries/diagnostic imaging
- Vascular System Injuries/microbiology
- Vascular System Injuries/mortality
- Vascular System Injuries/surgery
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Affiliation(s)
- Anica Ilic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Ksenija Stevanovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia.
| | - Sinisa Pejkic
- Department of Vascular Surgery, Mater Dei Hospital, Msida, Malta
| | - Miroslav Markovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - Andreja Dimic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - Milos Sladojevic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - Lazar Davidovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia
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Liebetrau D, Feder E, Zerwes S, Goßlau Y, Hyhlik-Dürr A. [Treatment strategies and outcomes for injection-associated inguinal perivascular abscesses in intravenous drug addicts]. Chirurg 2020; 92:1033-1039. [PMID: 32060577 PMCID: PMC8536638 DOI: 10.1007/s00104-020-01137-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Hintergrund Langzeitdrogenabhängige präsentieren sich nach dem Verbrauch der oberflächlichen Venen regelmäßig mit tiefen inguinalen vaskulär assoziierten Abszessen infolge fortgesetzter Drogeninjektionen. Die Behandlung dieser Komplikationen stellt anhaltend eine große medizinische Herausforderung dar. Bisher werden keine einheitlichen Therapieregime in der Literatur beschrieben. Fragestellung Welche Behandlungsstrategien und Ergebnisse gibt es bei injektionsassoziierten inguinalen perivaskulären Abszessen bei Drogenabhängigen? Material und Methoden Die Daten aller im Zeitraum zwischen 01.01.2004 und 31.05.2019 am Universitätsklinikum Augsburg behandelten Drogenkonsumenten wurden retrospektiv aufgearbeitet und mit der vorliegenden Literatur verglichen. Ergebnisse Es konnten 37 Fälle (männlich = 25, weiblich = 12) nach Anwendung der Einschlusskriterien in die Datenerhebung eingeschlossen werden. Das mediane Alter im untersuchten Patientenkollektiv lag bei 34,3 Jahren. Die 30-Tage-Mortalität lag bei 2,7 % (1/37). Die Amputationsrate betrug 2,8 %. Im untersuchten Kollektiv lag bei 13 Patienten eine arterielle Beteiligung vor. In 5 Fällen wurde primär arteriell ligiert. Bei weiteren 5 Fällen wurde primär eine Rekonstruktion mittels autologen Interponats durchgeführt. In weiteren 3 Fällen erfolgte die Anlage eines Obturatorbypasses (1/3) sowie die Durchführung einer Patchplastik (2/3). Die Offenheitsrate nach arterieller Rekonstruktion lag bei 87,5 % bei einem mittleren Follow-up von 421 Tagen. Die Gesamtkomplikationsrate lag bei 51,4 %. Diskussion Bei vaskulärer Beteiligung ist ein situationsgerechtes Vorgehen sinnvoll. Neben der Beseitigung komplizierter, septisch-venöser Thrombosen erscheint die Korrektur arterieller Blutungen mittels autologer Rekonstruktionsmaßnahmen aussichtsreich.
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Affiliation(s)
- D Liebetrau
- Klinik für Gefäßchirurgie und endovaskuläre Chirurgie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland.
| | - E Feder
- Klinik Günzburg, Ludwig-Heilmeyer-Straße 1, 89312, Günzburg, Deutschland
| | - S Zerwes
- Klinik für Gefäßchirurgie und endovaskuläre Chirurgie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - Y Goßlau
- Klinik für Gefäßchirurgie und endovaskuläre Chirurgie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
| | - A Hyhlik-Dürr
- Klinik für Gefäßchirurgie und endovaskuläre Chirurgie, Universitätsklinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland
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Elahwal M, Gaweesh AS, Elemam A, Moustafa S. Predictors of Limb Outcome Following Arterial Ligation of Infected Femoral Pseudoaneurysms in Drug Abusers. Ann Vasc Surg 2019; 65:130-136. [PMID: 31705992 DOI: 10.1016/j.avsg.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/01/2019] [Accepted: 11/01/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND We aimed to study variables affecting limb outcome following ligation of infected femoral pseudoaneurysms in intravenous drug abusers (IVDA)in the emergency setting and to propose an algorithm for management. DESIGN Prospective study. METHODS We studied short-term outcomes of 26 IVDA presenting with infected femoral pseudoaneurysms who underwent arterial ligation, hematoma evacuation, and debridement. Long-term results pertaining to limb functionality were unfeasible, as all patients were lost to follow-up. We aimed to study the potential predictors that might impact limb outcome in the emergency setting, namely: 1) mode of presentation (impending versus ruptured), 2) site of arterial ligation (above versus below inguinal ligament), 3) presence or absence of pedal Doppler flow post-ligation, and 4) ankle brachial pressure index (ABI) pre- and post-ligation. RESULTS Arterial ligation without revascularization was done in 19 (73.1%) of our patients, requiring no further intervention for limb salvage during their hospital stay. Four patients (15.4%) required iliopopliteal bypass, and 3 patients (11.5%) required major amputations (2 hip disarticulations and one above-knee amputation). In total, 23 limbs (88.5%) were salvaged. Proximal arterial ligation was done below the inguinal ligament (common femoral artery) in 21 patients (80.8%), while in the remaining 5 patients (19.2%), higher ligation was done above the inguinal ligament (external iliac artery). All 19 patients who were compensated had pedal Doppler flow post-ligation, and 18 of them had arterial ligation done below the inguinal ligament. The mean preoperative ABI (±SD) was 0.87 ± 0.34, and the mean postoperative ABI (±SD) was 0.37 ± 0.27. The mean change in ABI (±SD) was 0.50 ± 0.32. CONCLUSIONS Arterial ligation with local debridement alone is a safe procedure and would have salvaged 73.1% of limbs in this study. However, implementing a selective approach for post-ligation revascularization and our proposed algorithm increased limb salvage rate to 88.5%. The detection of pedal Doppler flow after ligation can stratify patients in whom urgent revascularization might not be required for limb salvage. Additionally, all efforts should be made to ligate the femoral artery below the inguinal ligament to preserve important juxta-inguinal collateral branches.
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Affiliation(s)
- Mohamed Elahwal
- Department of Vascular Surgery, Alexandria Faculty of Medicine, University of Alexandria, Alexandria, Egypt; Vascular Surgery Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
| | - Ahmed Sherif Gaweesh
- Department of Vascular Surgery, Alexandria Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Ali Elemam
- Department of Vascular Surgery, Alexandria Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Sameh Moustafa
- Department of Vascular Surgery, Alexandria Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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Becker D, Béguin M, Weiss S, Wyss TR, Schmidli J, Makaloski V. In situ Reconstruction of Infected Groin Pseudoaneurysms in Drug Abusers With Biological Grafts. Eur J Vasc Endovasc Surg 2019; 58:592-598. [DOI: 10.1016/j.ejvs.2019.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/27/2019] [Accepted: 04/28/2019] [Indexed: 02/07/2023]
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Kakisis JD. Mycotic Pseudoaneurysms in Drug Abusers: Still Looking for the Best Weapon for an Old Enemy. Eur J Vasc Endovasc Surg 2019; 58:599. [PMID: 31350136 DOI: 10.1016/j.ejvs.2019.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- John D Kakisis
- Department of Vascular Surgery, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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12
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Eley CL, Williams DT. Coil Embolization of Femoral Pseudoaneurysms in Intravenous Drug Users: An Additional Treatment Modality. Ann Vasc Surg 2019; 58:317-325. [PMID: 30731229 DOI: 10.1016/j.avsg.2018.10.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND This report describes our centers' experience of a new approach using coil embolization for femoral pseudoaneurysms (PSAs) in intravenous drug users (IVDUs). Current treatment options for this challenging patient group include femoral/external iliac artery ligation and excision of the PSA, with or without revascularization. Radiological thrombin injection, endoluminal stent grafting, and coil embolization have not been widely studied in this patient group and are most commonly reserved for sterile PSAs. METHODS A series of 6 patients who presented to the vascular surgical department with IVDU-related PSA were treated with coil embolization. We present here their clinical course and outcomes. Ethical approval was not required. RESULTS Coil embolization alone did not result in a satisfactory outcome. Thirty-three percent of patients required vessel ligation following their initial treatment with coil embolization. However, all patients initially managed with coil embolization, whether as a definitive treatment or temporizing measure to surgery, were discharged home, mobilizing well, with Doppler signals at the ankle. Postoperative claudication was present in 17% of patients. There were no amputations as a direct result of coil embolization. The amputation in this series resulted from triple-vessel ligation without revascularization in a patient mistaken as having a groin abscess. CONCLUSIONS Coil embolization is a potential, less invasive treatment option in selected cases of IVDU PSA. It offers an alternative therapeutic intervention, adding to the armamentarium available to tackle these often challenging patients.
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Affiliation(s)
- Catherine L Eley
- Ysbyty Gwynedd Hospital, Betsi Cadwaladr University Health Board, Penrhosgardnedd, Bangor, UK.
| | - Dean T Williams
- Ysbyty Gwynedd Hospital, Betsi Cadwaladr University Health Board, Penrhosgardnedd, Bangor, UK; School of Medical Sciences, Bangor University, Bangor, UK
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Salzler GG, Long B, Avgerinos ED, Chaer RA, Leers S, Hager E, Makaroun MS, Eslami MH. Contemporary Results of Surgical Management of Peripheral Mycotic Aneurysms. Ann Vasc Surg 2018; 53:86-91. [DOI: 10.1016/j.avsg.2018.04.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 11/28/2022]
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Right Subclavian Septic Pseudoaneurysm with Esophageal Fistula due to a Swallowed Fishbone. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2018.01.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Rossetti P, Perini P, Ucci A, Carolla G, Freyrie A, Quintavalla R. Surgical Treatment of a High-Flow Femoro-Femoral Arteriovenous Fistula in an Intravenous Drug Abuser. Ann Vasc Surg 2018; 51:327.e15-327.e19. [PMID: 29772331 DOI: 10.1016/j.avsg.2018.02.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/18/2018] [Accepted: 02/23/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND We report the surgical treatment of a high-flow femoro-femoral arteriovenous fistula (AVF), a rare complication of intravenous drug abuse. METHODS A 36-year-old woman with history of intravenous heroin and cocaine abuse presented with right lower limb edema, inguinal bruit, and heart failure. Duplex ultrasound examination (DUS) and computed tomography angiography showed a large, high-flow AVF involving the common femoral vein and the superficial femoral artery, which is associated with thrombosis of the great saphenous vein and an important inflammation in the right groin, without active bleeding. Under general anesthesia, the patient underwent open surgical repair of the AVF through a right-groin cutdown. The 3-cm-long AVF was repaired with the interposition of a bovine pericardium patch that is sewn from inside the femoral vein through a longitudinal venotomy with a continuous 5-0 polypropylene suture. RESULTS The venotomy was repaired with a 5-0 polypropylene running suture. No perioperative or postoperative complications were recorded. The inguinal bruit resolved, the arteries recovered good pulsatility, and the lower limb edema promptly reduced. A 6-month DUS confirmed the patency of the femoral arteries and veins and the absence of AVF or infection signs in the right groin. CONCLUSIONS Surgical repair of femoro-femoral AVF in drug abusers by biologic patch interposition is a challenging, but feasible, and effective technique with encouraging midterm results in terms of patency and resistance to infections.
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Affiliation(s)
- Pietro Rossetti
- Internal Medicine, Angiology and Coagulation Unit, University Hospital of Parma, Parma, Italy
| | - Paolo Perini
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Alessandro Ucci
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gaetano Carolla
- Internal Medicine, Angiology and Coagulation Unit, University Hospital of Parma, Parma, Italy
| | - Antonio Freyrie
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Roberto Quintavalla
- Internal Medicine, Angiology and Coagulation Unit, University Hospital of Parma, Parma, Italy
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Rammell J, Kansal N, Bhattacharya V. Management options in the treatment of femoral pseudoaneurysms secondary to intravenous drug abuse: A case series. Int J Surg Case Rep 2017; 36:30-33. [PMID: 28528282 PMCID: PMC5440756 DOI: 10.1016/j.ijscr.2017.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/26/2017] [Accepted: 04/30/2017] [Indexed: 11/16/2022] Open
Abstract
Infected femoral pseudoaneurysms are a common presentation in intravenous drug users with little consensus as to their optimum management. Excision and ligation of the femoral artery without revascularisation is the most common operative intervention. With the identification and optimisation of suitable patients, revascularisation can be performed in the emergency setting. Current endovascular approaches appear to be used only as a bridge to a future definitive revascularisation procedure. Ligation of the common femoral artery without revascularisation is both safe and effective as most patients will avoid critical ischaemia.
Introduction Infected femoral pseudoaneurysms are a common presentation in intravenous drug users with little consensus as to the optimum management of these patients. Whilst emergency revascularisation options are available, excision and ligation of the femoral artery remains the most common operative intervention but risks leaving the patient with critical ischaemia or intermittent claudication. This case series reviewed the outcomes of 4 patients who underwent excision-ligation without revascularisation of an infected femoral pseudoaneurysm at a district general hospital. Presentation Four patients (2 male, 2 female) with infected femoral pseudoaneurysms presented via the emergency room with diagnosis confirmed with contrast cross-sectional imaging. All patients underwent emergency excision and ligation of the pseudoaneurysm without revascularisation. One patient returned to theatre with critical ischaemia necessitating a hindquarter amputation. The remaining 3 patients were discharged without claudication symptoms. Conclusion With the identification of suitable patients and pre-operative optimisation, revascularisation can be performed in the emergency setting with an extra-anatomical bypass appearing to confer the best results. Currently endovascular approaches appear to be used only as a bridge to a future definitive revascularisation procedure, however, there are several case reports documenting successful outcomes when using a stent graft alongside a prolonged course of antibiotics. For the majority of patients, excision-ligation without revascularisation is both safe and effective as few are left with symptoms of limb ischaemia.
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Affiliation(s)
- James Rammell
- Department of Vascular Surgery, Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead, NE9 6SX, United Kingdom.
| | - Nisheeth Kansal
- Department of Vascular Surgery, Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead, NE9 6SX, United Kingdom
| | - Vish Bhattacharya
- Department of Vascular Surgery, Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead, NE9 6SX, United Kingdom
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Domanin M, Romagnoni G, Romagnoli S, Rolli A, Gabrielli L. Emergency Hybrid Approach to Ruptured Femoral Pseudoaneurysm in HIV-positive Intravenous Drug Abusers. Ann Vasc Surg 2016; 40:297.e5-297.e12. [PMID: 27908808 DOI: 10.1016/j.avsg.2016.07.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/06/2016] [Accepted: 07/30/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic traumatism of the common femoral artery due to intravenous injection in drug abusers, in association with local infections and arterial wall weakening caused by human immunodeficiency virus (HIV), can lead to the development of pseudoaneurysms (PSAs). Rupture of PSA is a dramatic event in such patients, and its correction is difficult and controversial. Most of the cases reported describe open surgical elective options, which consist in ligation, repair, or substitution of the damaged arterial segment, using when possible biological grafts. In literature, few cases describe an endovascular repair with covered stent deployment. METHODS We present 2 cases of HIV-positive intravenous injection in drug abusers who needed emergency treatment for active bleeding in ruptured PSA of the right common femoral artery. In both cases, under general anesthesia needed for lack of patient's compliance and unstable hemodynamics, a short dissection to the distal superficial femoral artery was required. RESULTS Then, maintaining a manual compression on the bleeding site to stop hemorrhage, we deployed a covered stent graft in the site of the arterial breakdown through a retrograde approach. CONCLUSIONS The favorable results and progressive healing of wound and local infections persuaded us not to perform any further surgical correction. The absence of recurrences and late complications, after 3 years in the first case and 1 year in the second one, lead us to consider this hybrid endovascular approach as a valuable alternative to open surgery in HIV intravenous injection in drug abuser patients, in particularly when emergency conditions occur.
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Affiliation(s)
- Maurizio Domanin
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy; Unità Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy.
| | - Giovanni Romagnoni
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy
| | - Silvia Romagnoli
- Unità Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Antonio Rolli
- Unità Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
| | - Livio Gabrielli
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy; Unità Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy
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The Treatment of Infected Femoral Artery Pseudoaneurysms Secondary to Drug Abuse: 11 Years of Experience at a Single Institution. Ann Vasc Surg 2016; 36:35-43. [DOI: 10.1016/j.avsg.2016.03.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/12/2016] [Accepted: 03/23/2016] [Indexed: 11/22/2022]
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Moulakakis KG, Sfyroeras GS, Alexiou VG, Kakisis J, Lazaris A, Vasdekis SN, Brountzos EN, Geroulakos G. Endovascular Management of Infected Iliofemoral Pseudoaneurysms. Vasc Endovascular Surg 2016; 50:421-6. [DOI: 10.1177/1538574416655895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The treatment of infected iliofemoral pseudoaneurysms is challenging and controversial. We present our experience regarding the efficacy and outcome of endovascular treatment of infected iliofemoral arterial pseudoaneurysms with covered stents. Our experience with 5 cases showed that stent grafting combined with antibiotic therapy and provisional drainage may be a safe and effective option in patients with cancer, patients with history of multiple hip revisions, and drug-addicted users. In our small case series, the reinfection rate was null and no covered stent thrombosis occurred. These results are fairly encouraging, but further studies with longer follow-up in a larger number of patients are needed to confirm the efficacy and durability of the technique.
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Affiliation(s)
- Konstantinos G. Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - George S. Sfyroeras
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Vangelis G. Alexiou
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
| | - John Kakisis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Andreas Lazaris
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Spyridon N. Vasdekis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Elias N. Brountzos
- Department of Radiology, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - George Geroulakos
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
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Karkos CD, Kalogirou TE, Giagtzidis IT, Papazoglou KO. Ruptured mycotic common femoral artery pseudoaneurysm: fatal pulmonary embolism after emergency stent-grafting in a drug abuser. Tex Heart Inst J 2014; 41:634-7. [PMID: 25593530 DOI: 10.14503/thij-13-3882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The rupture of a mycotic femoral artery pseudoaneurysm in an intravenous drug abuser is a limb- and life-threatening condition that necessitates emergency intervention. Emergency stent-grafting appears to be a viable, minimally invasive alternative, or a bridge, to subsequent open surgery. Caution is required in cases of suspected concomitant deep vein thrombosis in order to minimize the possibility of massive pulmonary embolism during stent-grafting, perhaps by omitting stent-graft postdilation or by inserting an inferior vena cava filter first. We describe the emergency endovascular management, in a 60-year-old male intravenous drug abuser, of a ruptured mycotic femoral artery pseudoaneurysm, which was complicated by a fatal pulmonary embolism.
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MESH Headings
- Aneurysm, False/diagnosis
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Aneurysm, Ruptured/diagnosis
- Aneurysm, Ruptured/microbiology
- Aneurysm, Ruptured/surgery
- Blood Vessel Prosthesis Implantation/adverse effects
- Drug Users
- Emergencies
- Endovascular Procedures/adverse effects
- Fatal Outcome
- Femoral Artery/diagnostic imaging
- Femoral Artery/microbiology
- Femoral Artery/surgery
- Humans
- Male
- Middle Aged
- Pulmonary Embolism/diagnosis
- Pulmonary Embolism/etiology
- Radiography, Interventional
- Substance Abuse, Intravenous/complications
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Stent-graft placement with early debridement and antibiotic treatment for femoral pseudoaneurysms in intravenous drug addicts. Cardiovasc Intervent Radiol 2014; 38:565-72. [PMID: 25288174 DOI: 10.1007/s00270-014-0994-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Explore the application of endovascular covered stent-graft (SG) placement in femoral pseudoaneurysms in intravenous drug addicts. MATERIALS AND METHODS We evaluated a consecutive series of pseudoaneurysm in intravenous drug addicts treated with SGs from August 2010 to December 2013. RESULTS 15 patients with 16 arterial pseudoaneurysms were enrolled in this study. All were males with a mean age of 36.9 years. Hemorrhage was the most common reason (93.8 %) for seeking medical care, and 3 of these patients were in hemorrhagic shock at admission. All patients received broad-spectrum antibiotics, and debridement and drainage were implemented after SG placement. 7 of the 13 cases which had microbiologic results showed mixed infections, while gram-negative bacteria were the major pathogens. Except for 2 patients, who were lost to follow-up, two new pseudoaneurysms formed due to delayed debridement, and one stent thrombosis occurred, none of the remaining cases had SG infection or developed claudication. CONCLUSIONS SG placement controls massive hemorrhage rapidly, gives enough time for subsequent treatment for pseudoaneurysms due to intravenous drug abuse, and reduces the incidence of postoperative claudication. With appropriate broad-spectrum antibiotics and early debridement, the incidence of SG infection is relatively low. It is an effective alternative especially as temporary bridge measure for critical patients. However, the high cost, uncertain long-term prospects, high demand for medical adherence, and the risk of using the conduits for re-puncture call for a cautious selection of patients. More evidence is required for the application of this treatment.
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Behera C, Naagar S, Krishna K, Taraporewalla DR, Garudadhri G, Prasad K. Sudden death due to ruptured pseudoaneurysm of femoral artery in injected drug abusers – Report of four cases at autopsy and review of literature. J Forensic Leg Med 2014; 22:107-11. [DOI: 10.1016/j.jflm.2013.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 12/07/2013] [Indexed: 10/25/2022]
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Dawson J, Fitridge R. Update on aneurysm disease: current insights and controversies: peripheral aneurysms: when to intervene - is rupture really a danger? Prog Cardiovasc Dis 2013; 56:26-35. [PMID: 23993236 DOI: 10.1016/j.pcad.2013.05.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Peripheral artery aneurysms are rarer than abdominal aortic aneurysms (AAA), although the true prevalence is not well known. They often coexist with aortic and other peripheral artery aneurysms. In contrast to AAA, where the principal risk is that of rupture, thromboembolism is more common, contributing a bigger risk in the more common lesions. Although rupture does occur, with incidence related to anatomical site, aneurysm diameter cannot be used to guide management with the same confidence as in AAA. In addition, the rarity of these lesions results in a paucity of evidence with which to guide intervention. Consequently they are difficult lesions to manage, and numerous aneurysm and patient factors must be considered to provide treatment individualised for each case. We discuss popliteal, femoral, carotid, subclavian, upper limb, visceral and false aneurysms, focussing on the risk of rupture and thromboembolism, and current thresholds for intervention, based on the available published literature.
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Affiliation(s)
- Joe Dawson
- Discipline of Surgery, University of Adelaide, and Vascular Unit, The Queen Elizabeth Hospital, Adelaide, Australia
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24
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D'Ovidio C, Vellante P, Costantini S, Carnevale A. Death due to an unrecognized groin abscess in a drug addict: a retrospective study. J Forensic Leg Med 2013; 20:382-6. [PMID: 23756501 DOI: 10.1016/j.jflm.2013.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Revised: 10/12/2012] [Accepted: 03/02/2013] [Indexed: 10/27/2022]
Abstract
Intravenous drug injection persists despite health risks and medical complications. Venous thrombosis, septic thrombophlebitis, artery necrosis, arterio-venous fistula, mycotic aneurysm, dissecting hematoma, pseudoaneurysm formation, and soft tissues infections (i.e. abscesses, cellulitis, infected ulcers), are some of the major clinical consequences lives threatening. The aim of this work is to present this unusual autoptic case of a drug addict man died for an unrecognized groin abscess referred to the Institute of Legal Medicine, University of Chieti, causing femoral vein's erosion, and to analyse the most common patterns of vascular lesions among drug addicts. It could be stimulated a new scientific debate because groin injections and their vascular complications increase over years; while soft tissue infections may hide vascular lesions' diagnosis. So physicians should have a high index of suspicion for serious vascular problems, among intravenous drug users (IDUs): prevention for avoiding groin injection and a proper treatment are necessary.
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Affiliation(s)
- Cristian D'Ovidio
- Department of Medicine and Aging Sciences, Section of Legal Medicine, University G. d'Annunzio of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy.
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Busch A, Lorenz U, Tiurbe GC, Bühler C, Kellersmann R. Femoral vein obturator bypass revascularization in groin infectious bleeding: two case reports and review of the literature. J Med Case Rep 2013; 7:75. [PMID: 23506237 PMCID: PMC3607977 DOI: 10.1186/1752-1947-7-75] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 01/24/2013] [Indexed: 11/17/2022] Open
Abstract
Introduction Groin infections resulting in arterial bleeding due to bacterial vessel destruction are a severe challenge in vascular surgery. Patients with them most often present as emergencies and therefore need individualized reconstruction solutions. Case presentation Case 1 is a 67-year-old man with infectious bleeding after an autologous reconstruction of the femoral bifurcation with greater saphenous vein due to infection of a bovine pericard patch after thrombendarterectomy. Case 2 is a 35-year-old male drug addict and had severe femoral bleeding and infection after repeated intravenous and intra-arterial substance abuse. Both patients were treated with an autologous obturator bypass of the superficial femoral vein. We review the current literature and highlight our therapeutic concept of this clinical entity. Conclusions Treatment should include systemic antibiotic medication, surgical control of the infectious site, revascularization and soft tissue repair. An extra-anatomical obturator bypass with autologous superficial femoral vein should be considered as the safest revascularization procedure in infections caused by highly pathogenic bacteria.
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Affiliation(s)
- Albert Busch
- Department of General, Visceral, Vascular and Paediatric Surgery University Clinic of Würzburg, Oberdürrbacher Strasse 6, Würzburg, D-97080, Germany.
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Tratamiento conservador con prostaglandina E1 en isquemia aguda de miembro superior por drogas de abuso. Caso clínico. ANGIOLOGIA 2012. [DOI: 10.1016/j.angio.2011.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hu ZJ, Wang SM, Li XX, Li SQ, Huang XL. Tolerable Hemodynamic Changes after Femoral Artery Ligation for the Treatment of Infected Femoral Artery Pseudoaneurysm. Ann Vasc Surg 2010; 24:212-8. [DOI: 10.1016/j.avsg.2009.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 01/15/2009] [Accepted: 06/04/2009] [Indexed: 10/20/2022]
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Surgical Management of Infected Pseudoaneurysms in Intravenous Drug Abusers: Single Institution Experience and a Proposed Algorithm. World J Surg 2009; 33:1830-5. [DOI: 10.1007/s00268-009-0123-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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The Management of Mycotic Femoral Pseudoaneurysms in Intravenous Drug Abusers. Ann Vasc Surg 2009; 23:345-9. [DOI: 10.1016/j.avsg.2008.08.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 05/28/2008] [Accepted: 08/11/2008] [Indexed: 11/19/2022]
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Lupattelli T, Garaci FG, Basile A, Minnella DP, Casini A, Clerissi J. Emergency stent grafting after unsuccessful surgical repair of a mycotic common femoral artery pseudoaneurysm in a drug abuser. Cardiovasc Intervent Radiol 2008; 32:347-51. [PMID: 18931876 DOI: 10.1007/s00270-008-9401-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 05/16/2008] [Accepted: 05/27/2008] [Indexed: 01/28/2023]
Abstract
Mycotic false aneurysm caused by local arterial injury from attempted intravenous injections in drug addicts remains a challenging clinical problem. The continued increase in drug abuse has resulted in an increased incidence of this problem, particularly in high-volume urban centres. In the drug-abusing population, mycotic arterial pseudoaneurysms most often occur because of missed venous injection and are typically seen in the groin, axilla, and antecubital fossa. Mycotic aneurysms may lead to life-threatening haemorrhage, limb loss, sepsis, and even death. Any soft-tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management. We report a case of rupturing mycotic pseudoaneurysm of the left common femoral artery treated by surgical resection followed by vessel reconstruction with autologous material. Unfortunately, at the time of discharge a sudden leakage from the vein graft anastomosis occurred, with subsequent massive bleeding, and required emergent endovascular covered stenting. To the best of our knowledge, this is the first reported case of femoral artery bleeding in a drug abuser treated by stent graft placement.
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Affiliation(s)
- Tommaso Lupattelli
- Department of Interventional Radiology, Multimedica IRCCS, Sesto San Giovanni, Milan, Italy.
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31
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Sadat U, Noor N, See TC, Hayes PD. Endovascular management of an arteriovenous fistula and concomitant pseudoaneurysm in an intravenous drug abuser. Vasc Endovascular Surg 2008; 42:293-5. [PMID: 18316363 DOI: 10.1177/1538574408314439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
An interesting case of an intravenous drug abuser who had endovascular management of an arteriovenous fistula and concomitant pseudoaneurysm, resulting from recurrent puncture of the femoral artery is reported in this study.
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Affiliation(s)
- Umar Sadat
- Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge, UK.
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The issue of infected false aneurysms in drug addicts. COR ET VASA 2008. [DOI: 10.33678/cor.2008.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Georgiadis GS, Bessias NC, Pavlidis PM, Pomoni M, Batakis N, Lazarides MK. Infected False Aneurysms of the Limbs Secondary to Chronic Intravenous Drug Abuse: Analysis of Perioperative Considerations and Operative Outcomes. Surg Today 2007; 37:837-44. [PMID: 17879032 DOI: 10.1007/s00595-006-3495-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Accepted: 12/28/2006] [Indexed: 10/22/2022]
Abstract
PURPOSE To discuss the perioperative considerations and operative outcomes of 26 intravenous (i.v.) drug abusers who presented with infected false aneurysms of the limbs. METHODS The subjects were 20 men and 6 women with pseudoaneurysms (mean age 34 years, range 19-53 years). The femoral and brachial arteries were most commonly involved. All patients, except for those with active bleeding, underwent digital subtraction angiography or Doppler ultrasonography, or both. Treatment consisted of excision and ligation of the aneurysm and local debridement, followed by revascularization with a vein graft or vein patch angioplasty. RESULTS The presenting symptoms and signs included a pulsatile mass (69%), ischemic pain (23%), active bleeding (38.5%), signs of inflammation (61.5%), and positive blood culture (31%). Bleeding complications developed in two patients, who underwent subsequent extra-anatomic bypass. One of these patients had hip disarticulation and eventually died. None of the remaining patients had claudication or required an amputation. The mean follow-up period was 24 months (range: 3-50 months). Only five (19.2%) patients received drug rehabilitation, whereas the remaining patients admitted to continued drug abuse after discharge from hospital. CONCLUSIONS Limb salvage with immediate revascularization is safe and achieves functionality; therefore, its use is justified. Recidivism and continued abuse is the usual consequence after discharge from hospital, making recovery difficult.
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Affiliation(s)
- George S Georgiadis
- Department of Vascular Surgery, Demokritos University Hospital, Alexandroupolis, Greece
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35
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Georgiadis GS. Regarding "Infected femoral artery pseudoaneurysm in drug addicts: The beneficial use of the internal iliac artery for arterial reconstruction". J Vasc Surg 2007; 46:613; author reply 613-4. [PMID: 17826259 DOI: 10.1016/j.jvs.2007.04.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Accepted: 04/03/2007] [Indexed: 10/22/2022]
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Klonaris C, Katsargyris A, Papapetrou A, Vourliotakis G, Tsiodras S, Georgopoulos S, Giannopoulos A, Bastounis E. Infected femoral artery pseudoaneurysm in drug addicts: The beneficial use of the internal iliac artery for arterial reconstruction. J Vasc Surg 2007; 45:498-504. [PMID: 17254738 DOI: 10.1016/j.jvs.2006.11.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 11/01/2006] [Indexed: 02/02/2023]
Abstract
BACKGROUND Infected femoral artery pseudoaneurysm (IFAP) is a severe complication in parenteral drug abusers, with difficult and controversial management. Ligation alone without revascularization is frequently associated with later intermittent claudication and limb amputation. Furthermore, arterial reconstruction with a synthetic or venous conduit is limited because of a contaminated field and, often, unavailability of autologous venous grafts. In this study, we present our experience with the internal iliac artery (IIA) as a graft for arterial reconstruction after IFAP excision in these patients. METHODS Data of 14 consecutive patients who presented with IFAP secondary to parenteral drug abuse from 2001 to 2005 were analyzed. Twelve patients (85.7%) were male. The median age was 27 years (range, 19-42 years). In 13 cases, the IFAP involved the common femoral artery, and in 1 case it involved the profunda femoris artery (PFA). In nine patients, we used the IIA for arterial reconstruction (five as a patch and four as an interposition graft), whereas in two patients the arterial deficit was repaired with a great saphenous vein patch. In two cases, an extra-anatomic bypass with a synthetic polytetrafluoroethylene graft was performed. In one patient, the pseudoaneurysm involved the PFA and was treated with excision and ligation of the PFA. RESULTS All nine patients who underwent revascularization with the use of IIA were free of claudication symptoms. None of them experienced any perioperative complications, had signs of reinfection, or required limb amputation during the follow-up period (median, 19 months; range, 4-52 months). Regarding the remaining five patients, one died 25 days after surgery because of multiorgan failure, and one underwent reoperation because of proximal anastomotic rupture of a synthetic graft. The latter patient finally underwent a transmetatarsal amputation. CONCLUSIONS The use of IIA for arterial reconstruction after IFAP excision in drug abusers is safe and effective. These preliminary results indicate that the implementation of this technique offers many advantages compared with traditional treatment options.
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Affiliation(s)
- Chris Klonaris
- First Department of Surgery, Vascular Division, Athens University Medical School, Athens, Greece.
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