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MacLeod CS, Nagy J, Radley A, Khan F, Rae N, Wilson MSJ, Suttie SA. REPAIRS Delphi: A UK and Ireland Consensus Statement on the Management of Infected Arterial Pseudoaneurysms Secondary to Groin Injecting Drug Use. Eur J Vasc Endovasc Surg 2024; 68:530-540. [PMID: 38663765 DOI: 10.1016/j.ejvs.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/29/2024] [Accepted: 04/15/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVE Consensus guidelines on the optimal management of infected arterial pseudoaneurysms secondary to groin injecting drug use are lacking. This pathology is a problem in the UK and globally, yet operative management options remain contentious. This study was designed to establish consensus to promote better management of these patients, drawing on the expert experience of those in a location with a high prevalence of illicit drug use. METHODS A three round modified Delphi was undertaken, systematically surveying consultant vascular surgeons in the UK and Ireland using an online platform. Seventy five vascular surgery units were invited to participate, with one consultant providing the unit consensus practice. Round one responses were thematically analysed to generate statements for round two. These statements were evaluated by participants using a five point Likert scale. Consensus was achieved at a threshold of 70% or more agreement or disagreement. Those statements not reaching consensus were assessed and modified for round three. The results of the Delphi process constituted the consensus statement. RESULTS Round one received 64 (86%) responses, round two 59 (79%) responses, and round three 62 (83%) responses; 73 (97%) of 75 units contributed. Round two comprised 150 statements and round three 24 statements. Ninety one statements achieved consensus agreement and 15 consensus disagreement. The Delphi statements covered sequential management of these patients from diagnosis and imaging, antibiotics and microbiology, surgical approach, wound management, follow up, and additional considerations. Pre-operative imaging achieved consensus agreement (97%), with computed tomography angiography being the modality of choice (97%). Ligation and debridement without arterial reconstruction was the preferred approach at initial surgical intervention (89%). Multidisciplinary management, ensuring holistic care and access to substance use services, also gained consensus agreement. CONCLUSION This comprehensive consensus statement provides a strong insight into the standard of care for these patients.
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MESH Headings
- Humans
- Delphi Technique
- Substance Abuse, Intravenous/complications
- Ireland
- Aneurysm, False/etiology
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/therapy
- Aneurysm, False/diagnosis
- United Kingdom
- Consensus
- Groin/blood supply
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/surgery
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/therapy
- Vascular Surgical Procedures/adverse effects
- Vascular Surgical Procedures/standards
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Affiliation(s)
- Caitlin S MacLeod
- Department of Vascular Surgery, Ninewells Hospital, NHS Tayside, Dundee, UK; Division of Systems Medicine, University of Dundee, Dundee, UK.
| | - John Nagy
- Department of Vascular Surgery, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - Andrew Radley
- Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK; Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK
| | - Faisel Khan
- Division of Systems Medicine, University of Dundee, Dundee, UK
| | - Nikolas Rae
- Department of Infectious Diseases, Ninewells Hospital, NHS Tayside, Dundee, UK
| | | | - Stuart A Suttie
- Department of Vascular Surgery, Ninewells Hospital, NHS Tayside, Dundee, UK
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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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3
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Rabinovich Y, Klemperer LN, Levi Y, Rubinstein C, Rosenthal E, Sheick-Yousif B. An out of the box treatment for an infected pseudoaneurysm: Deep to superficial femoral artery transposition. J Vasc Surg Cases Innov Tech 2023; 9:101199. [PMID: 37333863 PMCID: PMC10273281 DOI: 10.1016/j.jvscit.2023.101199] [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] [Received: 01/21/2023] [Accepted: 04/05/2023] [Indexed: 06/20/2023] Open
Abstract
An infected pseudoaneurysm is a condition that has become more common in recent years, with the proliferation of endovascular intervention and the use of intravenous drugs. If left untreated, an infected pseudoaneurysm can progress to rupture, which can lead to life-threatening hemorrhage. No clear consensus has been reached among vascular surgeons regarding the management of infected pseudoaneurysms, and the literature describes a wide range of treatment techniques. In the present report, we describe an "out of the box" approach to infected pseudoaneurysms: a superficial femoral artery to deep femoral artery transposition, as an alternative to ligation with or without bypass reconstruction. We also describe our experience with six patients who underwent this procedure with 100% technical success and limb salvage rates. Although we implemented this technique for cases of infected pseudoaneurysms, we believe it can also be applied to other cases of femoral pseudoaneurysms when angioplasty or graft reconstruction is not feasible. However, further research with larger cohorts is warranted.
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Affiliation(s)
| | | | | | | | - Eyal Rosenthal
- Correspondence: Eyal Rosenthal, MD, Department of Vascular Surgery, Tel Aviv Sourasky Medical Center, Weizmann 2 St, Tel Aviv, Israel
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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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Sarkar M, Fridling J, Nagarsheth K. Post-Operative Ischemia and Surgical Technique Affect Late Mortality of Femoral Artery Pseudoaneurysms Following Injection Drug Use. Ann Vasc Surg 2022; 92:231-239. [PMID: 36584967 DOI: 10.1016/j.avsg.2022.12.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/04/2022] [Accepted: 12/16/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Surgical management of infected common femoral artery (CFA) pseudoaneurysms arising from intravenous drug use (IVDU) is clinically challenging with excellent perioperative outcomes reported for a number of techniques. Long-term outcomes after arterial ligation versus revascularization are not known. We report both short- and long-term comparison of lower extremity perfusion and outcomes for 25 patients that underwent simple or more extensive ligation or revascularization treatment. METHODS A retrospective analysis of 25 consecutive patients presenting primarily with infected CFA pseudoaneurysms related to IVDU at one referral institution was performed to determine short- and long-term outcomes at time of discharge, 30 days, and 1 year, including intraoperative differences, postoperative and follow-up ankle-brachial index, bacteriology, and postoperative mortality. In addition to a direct comparison between the revascularization patients (n = 12) and simple ligation patients (n = 13), a comparison within the simple ligation group was performed between those who underwent a ligation of the CFA with preservation of the femoral bifurcation (double ligation) and those who underwent ligation of the CFA, superficial femoral artery, and profunda femoral artery individually (triple ligation [TL]). RESULTS All techniques resulted in similar mortality at 30 days. Lower extremity perfusion at discharge was highest in the revascularization group, and lowest in the TL patients. One year mortality was significantly higher in the TL cohort. CONCLUSIONS This is the first report of long-term outcomes after surgery for infected CFA pseudoaneurysms, and demonstrates increased late mortality in patients treated with extensive (triple) ligation with persistent ischemia. We conclude that revascularization after resection of infected CFA aneurysms, or surgical techniques that preserve or recreate the femoral artery bifurcation cause less ischemia and late mortality in these challenging patients.
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Affiliation(s)
- Malini Sarkar
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
| | - Jeremy Fridling
- Department of Surgery, University of Connecticut Health, Farmington, CT
| | - Khanjan Nagarsheth
- Division of Vascular Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
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6
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Elzawy G, Eisenberg N, Jaberi A, Roche-Nagle G. Vascular surgical management of profunda femoris artery aneurysms: A single center experience. Vascular 2022:17085381221084811. [PMID: 35324355 DOI: 10.1177/17085381221084811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Profunda femoris artery aneurysms (PFAAs), which comprise true profunda femoris artery aneurysms (TPFAAs) and profunda femoris artery pseudoaneuryms (PFA PSAs), are rare but clinically significant diseases of the peripheral arterial vasculature. Our aim is to describe our institution's 15-year experience with PFAAs (TPFAAs and PFA PSAs) to provide insight into patient characteristics, diagnostic imaging modalities, and surgical interventions that contribute to clinically important outcomes in patients with PFAAs. METHODS We conducted a retrospective study at our institution using our radiology database. RESULTS We identified six patients with PFA PSAs and four patients with TPFAAs. The clinical presentation of PFA PSAs included a triad of thigh pain, bleeding, and unexplained anemia. There was variety in the aetiologies of PFA PSAs, arising from catheterizations, upper thigh fractures, anastomotic complications, or unknown causes. Most patients with PFA PSAs had hypertension and coronary artery disease, and half of our cohort had peripheral vascular disease. All patients were imaged with duplex ultrasonography (DUS) or computed tomography (CT), the latter being more accurate. All patients with PFA PSAs underwent endovascular treatment, including glue, thrombin, or coil embolization as well as stent-graft insertions. All TPFAAs presented to our center were small and incidentally discovered, explaining the conservative management of our TPFAAs. Two of the four TPFAAs were idiopathic in nature, while one was attributed to post-stenotic dilatation, and another was found in a patient with Ehlers Danlos Syndrome. There was an association between TPFAAs and multiple synchronous or asynchronous aneurysms. CONCLUSION Pseudoaneurysms of the PFA are mostly iatrogenic in nature and can present with the triad of thigh swelling, bleeding, and unexplained anemia. If the clinical picture is suggestive of a PFA PSA but DUS does not detect a pseudoaneurysm, CT may be added as a more accurate imaging modality. Endovascular embolization is used in smaller pseudoaneurysms and in poor surgical candidates. Multiple glue, coil, or thrombin injections may be required to fully thrombose the pseudoaneurysm sac. True aneurysms of the PFA are associated with synchronous/asynchronous aneurysms and small TPFAAs should be carefully monitored, as there is a risk of enlargement and rupture.
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Affiliation(s)
- George Elzawy
- Temerty Faculty of Medicine, 12366University of Toronto, Toronto, Canada
| | - Naomi Eisenberg
- Temerty Faculty of Medicine, 12366University of Toronto, Toronto, Canada.,Division of Vascular Surgery, Peter Munk Cardiac Center, University Health Network, Toronto, Canada
| | - Arash Jaberi
- Division of Interventional Radiology, Peter Munk Cardiac Center, 7989University Health Network, Toronto, Canada
| | - Graham Roche-Nagle
- Division of Interventional Radiology, Peter Munk Cardiac Center, 7989University Health Network, Toronto, Canada.,Division of Vascular Surgery, Peter Munk Cardiac Center, University Health Network, Toronto, Canada
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7
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Sun P, Zhang L, Gu Y, Wei S, Wang Z, Li M, Wang W, Wang Z, Bai H. Immune checkpoint programmed death-1 mediates abdominal aortic aneurysm and pseudoaneurysm progression. Biomed Pharmacother 2021; 142:111955. [PMID: 34339918 DOI: 10.1016/j.biopha.2021.111955] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The causes and pathogenetic mechanisms underlying abdominal aortic aneurysms (AAAs) and pseudoaneurysms are not fully understood. We hypothesized that inhibiting programmed death-1 (PD-1) can decrease AAA and pseudoaneurysm formation in mouse and rat models. METHODS Human AAA samples were examined in conjunction with an adventitial calcium chloride (CaCl2) application mouse model and an aortic patch angioplasty rat model. Single-dose PD-1 antibody (4 mg/kg) or BMS-1 (PD-1 inhibitor-1) (1 mg/kg) was administered by intraperitoneal (IP) or intraluminal injection. In the intramural injection group, PD-1 antibody was injected after CaCl2 incubation. The rats were divided into three groups: (1) the control group was only decellularized without other special treatment, (2) the PD-1 antibody-coated patch group, and (3) the BMS-1 coated patch group. Patches implanted in the rat abdominal aorta were harvested on day 14 after implantation and analyzed. RESULTS Immunohistochemical analysis showed PD-1-positive cells, PD-1 and CD3, PD-1 and CD68, and PD-1 and α-actin co-expressed in the human AAA samples. Intraperitoneal (IP) injection or intraluminal injection of PD-1antibody/BMS-1 significantly inhibited AAA progression. PD-1 antibody and BMS-1 were each successfully conjugated to decellularized rat thoracic artery patches, respectively, by hyaluronic acid. Patches coated with either humanized PD-1 antibody or BMS-1 can also inhibit pseudoaneurysm progression and inflammatory cell infiltration. CONCLUSION PD-1 pathway inhibition may be a promising therapeutic strategy for inhibiting AAA and pseudoaneurysm progression.
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MESH Headings
- Aneurysm, False/drug therapy
- Aneurysm, False/metabolism
- Aneurysm, False/pathology
- Angioplasty/methods
- Animals
- Antibodies, Monoclonal, Humanized/pharmacology
- Antibodies, Monoclonal, Humanized/therapeutic use
- Aortic Aneurysm, Abdominal/drug therapy
- Aortic Aneurysm, Abdominal/metabolism
- Aortic Aneurysm, Abdominal/pathology
- B7-H1 Antigen/antagonists & inhibitors
- B7-H1 Antigen/metabolism
- Calcium Chloride/toxicity
- Coated Materials, Biocompatible/pharmacology
- Coated Materials, Biocompatible/therapeutic use
- Disease Models, Animal
- Disease Progression
- Humans
- Immune Checkpoint Inhibitors/pharmacology
- Immune Checkpoint Inhibitors/therapeutic use
- Injections, Intraperitoneal
- Lymphocytes/immunology
- Macrophages/immunology
- Male
- Mice
- Programmed Cell Death 1 Receptor/antagonists & inhibitors
- Programmed Cell Death 1 Receptor/immunology
- Programmed Cell Death 1 Receptor/metabolism
- Rats, Sprague-Dawley
- Rats
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Affiliation(s)
- Peng Sun
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, 450052 Henan, China
| | - Liwei Zhang
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, 450052 Henan, China
| | - Yulei Gu
- Emergency Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, 450052 Henan, China
| | - Shunbo Wei
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, 450052 Henan, China
| | - Zhiwei Wang
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, 450052 Henan, China
| | - Mingxing Li
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, 450052 Henan, China
| | - Wang Wang
- Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, 450002 Henan, China; Department of Physiology, Medical School of Zhengzhou University, 450002 Henan, China
| | - Zhiju Wang
- Department of Physiology, Medical School of Zhengzhou University, 450002 Henan, China
| | - Hualong Bai
- Department of Vascular and Endovascular Surgery, First Affiliated Hospital of Zhengzhou University, 450052 Henan, China; Key Vascular Physiology and Applied Research Laboratory of Zhengzhou City, 450002 Henan, 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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Percutaneous balloon-assisted ultrasound-guided direct glue embolization of deep femoral artery pseudoaneurysm rupture. Radiol Case Rep 2020; 16:425-429. [PMID: 33363675 PMCID: PMC7750146 DOI: 10.1016/j.radcr.2020.12.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/06/2020] [Indexed: 11/24/2022] Open
Abstract
Deep femoral artery pseudoaneurysm is commonly caused by arterial access in endovascular procedures. Some therapeutic options have been applied for this lesion such as: surgery, ultrasound-guided compression, direct thrombin injection, covered stent, coil embolization. One of the effective therapeutic for treatment of femoral artery pseudoaneurysm but uncommon use is percutaneous direct glue injection. We hereby report a case of right deep femoral artery pseudoaneurysm after 2-week placement of the femoral tunneled hemodialysis catheter which was successfully treated by balloon-assisted percutaneous ultrasound-guided direct glue embolization.
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10
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Contralateral internal iliac artery transposition for retroperitoneal sarcoma involving common iliac artery. Updates Surg 2020; 74:1157-1163. [PMID: 32602011 DOI: 10.1007/s13304-020-00843-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/25/2020] [Indexed: 01/20/2023]
Abstract
Complete resection for retroperitoneal sarcoma (RPS) involving major vessels frequently requires vascular resection and reconstruction. The use of artificial grafts often leads to postoperative vascular graft infection (VGI), which usually requires reoperation and sometimes leads to death. In the present study, the data of RPS patients who underwent contralateral iliac artery (IIA) transposition for reconstruction of the common iliac artery (CIA) after RPS resection from 2015-2019 were retrospectively analyzed. Clinical, intraoperative, and postoperative outcomes were described. Contralateral IIA transposition was performed to reconstruct the CIA after segmental resection in three patients. All patients underwent concomitant organ resection. Colon resection was performed for all patients, nephrectomy was performed for two patients, and segmental resection of the left ureter with transurethral ureterostomy was performed for one patient. Complete resection was achieved in all patients, and microscopic tumor infiltration to the CIA was observed in all patients (tunica adventitia: 2, tunica media: 1). No major complications occurred during the hospital stay. During the follow-up period (6.0-29.1 months), one patient died from tumor recurrence, and the other two patients did not have any evidence of recurrence or metastatic disease at the latest follow-up. The level of lower limb function was favorable (MSTS93 scores: 28-30). The pelvic organ functions, including bowel, bladder, and sexual functions, were not impaired in any of the patients. This novel technique in which contralateral IIA transposition is performed to reconstruct the CIA after RPS resection is simple and reliable and may be a good alternative to artificial grafts.
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Samarakoon LB, Ho DCY, Tan YK, Kum SWC, Lim DM. Infected femoral pseudoaneurysms in intravenous drug abusers: a decade of experience from a Singapore tertiary centre. Singapore Med J 2020; 62:135-138. [PMID: 32147737 DOI: 10.11622/smedj.2020011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION A pseudoaneurysm (or false aneurysm) is a haematoma that communicates with an artery through a disruption in the arterial wall. The femoral artery is the most common injection site among drug users, and infected femoral pseudoaneurysms are the most common vascular complications. METHODS A retrospective review of medical records of intravenous drug abusers (IVDAs) who presented with infected femoral pseudoaneurysms from January 2006 to December 2016 was carried out. Patients who had pseudoaneurysms due to other aetiologies or trauma were excluded. RESULTS A total of 27 patients with infected femoral pseudoaneurysms were identified. The majority were male (92.6%) and of Malay ethnicity (55.6%). Median age was 50 (range 31-62) years. Commonly abused drugs were buprenorphine (or Subutex; 59.3%) and midazolam (or Dormicum; 51.9%). Groin pain and swelling (100.0%), fever (66.7%) and presence of a pulsatile mass (51.9%) were the most common presenting symptoms. Diagnosis was confirmed via computed tomography angiography in all patients. 25 patients underwent upfront arterial ligation with debridement, among whom three patients required concurrent surgical revascularisation. Only two patients underwent ultrasonography-guided thrombin injection - one eventually required surgery and the other was lost to follow-up. Postoperative complications included wound infection (42.3%), bleeding (11.5%) and necrotising fasciitis eventually resulting in limb loss (3.8%). There were no associated mortalities. CONCLUSION Infected pseudoaneurysms in IVDAs pose a unique challenge to vascular surgeons. We found that simple ligation and debridement was a safe and effective option for such patients.
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Affiliation(s)
| | | | - Yih Kai Tan
- Department of General Surgery, Changi General Hospital, Singapore
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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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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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Ben Hammamia M, Fourati M, Ziadi J, Ghedira F, Ben Mrad M, Denguir R. [Femoral pseudoaneurysms in drug addicts: About 4 cases]. JOURNAL DE MÉDECINE VASCULAIRE 2018; 43:193-197. [PMID: 29754729 DOI: 10.1016/j.jdmv.2018.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 02/24/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To describe the therapeutic management of false aneurysms of the femoral artery in drug addicts. PATIENTS AND METHODS We report the cases of four drug addicts with pseudoaneurysms of the femoral artery. RESULTS All patients were male with a mean age of 36 years. Emergency surgical treatment involved removal of the pseudoaneurysm followed by a venous graft (n=3) or patch (n=1). The post-operative period was uneventful for three patients. One patient required early revision with a second venous bypass after bleeding from the first then later a second revision for resection of infected tissue and sartorius muscle plasty to cover the groin area. Late outcome was favorable for all patients after an average 12-month follow-up. CONCLUSION No consensus has been reached concerning the appropriate treatment for false aneurysms of the femoral artery in drug addicts. Analyses of larger series with longer follow-ups are needed to elucidate the best emergency surgical methods capable of reducing the risk of rupture.
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Affiliation(s)
- M Ben Hammamia
- Service de chirurgie cardio-vasculaire et thoracique, faculté de médecine de Tunis, CHU La Rabta, Bab-Saadoun, 1006 Tunis, Tunisie
| | - M Fourati
- Service de chirurgie cardio-vasculaire et thoracique, faculté de médecine de Tunis, CHU La Rabta, Bab-Saadoun, 1006 Tunis, Tunisie.
| | - J Ziadi
- Service de chirurgie cardio-vasculaire et thoracique, faculté de médecine de Tunis, CHU La Rabta, Bab-Saadoun, 1006 Tunis, Tunisie
| | - F Ghedira
- Service de chirurgie cardio-vasculaire et thoracique, faculté de médecine de Tunis, CHU La Rabta, Bab-Saadoun, 1006 Tunis, Tunisie
| | - M Ben Mrad
- Service de chirurgie cardio-vasculaire et thoracique, faculté de médecine de Tunis, CHU La Rabta, Bab-Saadoun, 1006 Tunis, Tunisie
| | - R Denguir
- Service de chirurgie cardio-vasculaire et thoracique, faculté de médecine de Tunis, CHU La Rabta, Bab-Saadoun, 1006 Tunis, Tunisie
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Bai H, Lee JS, Hu H, Wang T, Isaji T, Liu S, Guo J, Liu H, Wolf K, Ono S, Guo X, Yatsula B, Xing Y, Fahmy TM, Dardik A. Transforming Growth Factor-β1 Inhibits Pseudoaneurysm Formation After Aortic Patch Angioplasty. Arterioscler Thromb Vasc Biol 2017; 38:195-205. [PMID: 29146747 DOI: 10.1161/atvbaha.117.310372] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/07/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Pseudoaneurysms remain a significant complication after vascular procedures. We hypothesized that TGF-β (transforming growth factor-β) signaling plays a mechanistic role in the development of pseudoaneurysms. APPROACH AND RESULTS Rat aortic pericardial patch angioplasty was associated with a high incidence (88%) of pseudoaneurysms at 30 days, with increased smad2 phosphorylation in small pseudoaneurysms but not in large pseudoaneurysms; TGF-β1 receptors were increased in small pseudoaneurysms and preserved in large pseudoaneurysms. Delivery of TGF-β1 via nanoparticles covalently bonded to the patch stimulated smad2 phosphorylation both in vitro and in vivo and significantly decreased pseudoaneurysm formation (6.7%). Inhibition of TGF-β1 signaling with SB431542 decreased smad2 phosphorylation both in vitro and in vivo and significantly induced pseudoaneurysm formation by day 7 (66.7%). CONCLUSIONS Normal healing after aortic patch angioplasty is associated with increased TGF-β1 signaling, and recruitment of smad2 signaling may limit pseudoaneurysm formation; loss of TGF-β1 signaling is associated with the formation of large pseudoaneurysms. Enhancement of TGF-β1 signaling may be a potential mechanism to limit pseudoaneurysm formation after vascular intervention.
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Affiliation(s)
- Hualong Bai
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.)
| | - Jung Seok Lee
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.)
| | - Haidi Hu
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.)
| | - Tun Wang
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.)
| | - Toshihiko Isaji
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.)
| | - Shirley Liu
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.)
| | - Jianming Guo
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.)
| | - Haiyang Liu
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.)
| | - Katharine Wolf
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.)
| | - Shun Ono
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.)
| | - Xiangjiang Guo
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.)
| | - Bogdan Yatsula
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.)
| | - Ying Xing
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.)
| | - Tarek M Fahmy
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.)
| | - Alan Dardik
- From the Department of Vascular Surgery, First Affiliated Hospital of Zhengzhou University, Henan, China (H.B.); Basic Medical College of Zhengzhou University, Henan, China (H.B., Y.X.); Vascular Biology and Therapeutics Program (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), Department of Surgery (H.B., H.H., T.W., T.I., S.L., J.G., H.L., K.W., S.O., X.G., B.Y., A.D.), and Department of Immunobiology (T.M.F.), Yale University School of Medicine, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT (J.S.L., T.M.F.); and Department of Surgery, VA Connecticut Healthcare System, West Haven, CT (A.D.).
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Ahmad M, Poh YW, Imray CHE. A staged, endovascular approach to treat a ruptured external iliac artery mycotic pseudoaneurysm in an intravenous drug user: A case report. Int J Surg Case Rep 2017; 39:115-118. [PMID: 28826072 PMCID: PMC5565740 DOI: 10.1016/j.ijscr.2017.07.054] [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] [Received: 03/22/2017] [Revised: 07/29/2017] [Accepted: 07/29/2017] [Indexed: 11/25/2022] Open
Abstract
Initial hybrid approach to achieve haemorrhagic and sepsis control is a viable option as a bridge to delayed definitive arterial reconstruction . Endovascular stent-grafting provides an alternative treatment strategy to arterial ligation in cases of ruptured mycotic pseudoaneurysms. Anticipation of stent-graft infection can allow time to plan for delayed arterial reconstruction. Subsequent stent-graft removal and reconstruction can preclude complications of arterial ligation, including claudication and limb-loss.
Introduction Ruptured mycotic pseudoaneurysms are one of the ways IVDU patients can present in extremis. The principles of treatment include arterial ligation for haemorrhage control but can leave patients vulnerable subsequent limb ischaemia. Presentation of case We report a female IVDU presenting with abdominal pain and sepsis. Imaging demonstrated haemorrhage from an external iliac pseudoaneurysm. A two-staged hybrid approach with initial endografting and debridement for sepsis-control followed by delayed endograft removal and arterial reconstruction was successfully undertaken. Discussion The primary use of endovascular techniques to control haemorrhage in unstable patients is a useful adjunct to treat ruptured mycotic pseudoaneurysms in IVDU patients with delayed removal and arterial reconstruction. Conclusion We have shown a successful outcome in managing a challenging patient using endovascular techniques as a bridge to definitive arterial reconstruction. This circumvents traditional approaches including primary arterial ligation, which carry a risk of limb-loss.
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Affiliation(s)
- Mehtab Ahmad
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, United Kingdom.
| | - Yi Wen Poh
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, United Kingdom
| | - Christopher H E Imray
- University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Walsgrave, Coventry, CV2 2DX, United Kingdom
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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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Stevenson RP, Semple C, Hussey K, McGovern J, Stuart WP, Kingsmore DB. Changes in the demographics of intravenous drug users with mycotic common femoral artery pseudoaneurysm as a consequence of self-injection does not influence outcome following emergency ligation. Vascular 2017; 25:520-524. [DOI: 10.1177/1708538117700763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The reported annual incidence of mycotic pseudoaneurysm of the common femoral artery in intravenous drug users has been estimated at 0.03%. Over the past 5 years in Scotland, the proportion of people receiving specialist attention for heroin use over the age of 40 years has increased from 15 to 22%. Although routinely managed with arterial ligation (without reconstruction), some series have reported rates of major limb amputation of up to 10%. We sought to define whether this management strategy was still acceptable in an older population. Methods Retrospective review of patients presenting to a tertiary vascular service with mycotic pseudoaneurysm of the common femoral artery due to arterial injection by intravenous drug users between October 2010 and March 2016. Variables of interest included patient demographics and requirement for major amputation. Results There were 55 patients identified. The annual incidence of mycotic pseudoaneurysm of the common femoral artery in intravenous drug users was 2.1%. It was more common in men (3:1) and the mean age at presentation was 41 years (standard deviation ± 8 years). Three patients underwent major limb amputation during the index admission for severe limb ischaemia (two transfemoral amputations; one hip-disarticulation). Following discharge two patients were readmitted (134 and 200 days, respectively, following primary ligation) for major limb amputation due to of critical limb ischaemia. Conclusions Despite the increasing age of intravenous drug users presenting with mycotic pseudoaneurysm of the common femoral artery primary ligation of pseudoaneurysm would seem to remain an appropriate therapeutic intervention.
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Affiliation(s)
| | | | - Keith Hussey
- Department of Vascular Surgery, Queen Elizabeth University Hospital, UK
| | - Josh McGovern
- Department of Vascular Surgery, Queen Elizabeth University Hospital, UK
| | - Wesley P Stuart
- Department of Vascular Surgery, Queen Elizabeth University Hospital, UK
| | - David B Kingsmore
- Department of Vascular Surgery, Queen Elizabeth University Hospital, UK
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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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Mrad MB, Hammamia MB, Miri R, Derbel B, Koubaa MA, Ziadi J, Khayati A. [Aneurysm of the superficial femoral artery linked to a salmonella infection]. Pan Afr Med J 2015; 22:218. [PMID: 26955409 PMCID: PMC4760721 DOI: 10.11604/pamj.2015.22.218.7804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 09/08/2015] [Indexed: 11/15/2022] Open
Abstract
Les anévrismes infectieux de l'axe fémoro-poplité sont rares et d’évolution silencieuse. Ils surviennent surtout chez les sujets immunodéprimés. Leur traitement fait appel souvent à l'exclusion chirurgicale associée ou non à un geste de revascularisation. Nous rapportons le cas d'un patient opéré pour un anévrisme de l'artère fémorale superficielle, lié à une infection à salmonelle, il a eu une résection de l'anévrysme et une revascularisation par greffe veineuse. Ce patient a été repris par la suite à deux reprise pour rupture du greffon veineux. Pour cette raison, nous étions contraints à une explantation du pontage et une ligature des 2 bouts de l'artère sans revascularisation. Malgré l'absence de revascularisation, l’évolution a été favorable sous couverture d'une une antibiothérapie adaptée. En cas d'anévrysme infectieux de l'axe fémoro-poplité par infection à salmonelle, le rétablissement de la continuité artérielle, même avec un greffon veineux, peut exposer au risque de rupture artérielle.
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Affiliation(s)
- Melek Ben Mrad
- Service de Chirurgie Cardio-Vasculaire, Hôpital La Rabta, Tunis, Tunisie
| | | | - Rim Miri
- Service de Chirurgie Cardio-Vasculaire, Hôpital La Rabta, Tunis, Tunisie
| | - Bilel Derbel
- Service de Chirurgie Cardio-Vasculaire, Hôpital La Rabta, Tunis, Tunisie
| | | | - Jalel Ziadi
- Service de Chirurgie Cardio-Vasculaire, Hôpital La Rabta, Tunis, Tunisie
| | - Adel Khayati
- Service de Chirurgie Cardio-Vasculaire, Hôpital La Rabta, Tunis, Tunisie
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Saini NS, Luther A, Mahajan A, Joseph A. Infected pseudoaneurysms in intravenous drug abusers: Ligation or reconstruction? Int J Appl Basic Med Res 2014; 4:S23-6. [PMID: 25298938 PMCID: PMC4181127 DOI: 10.4103/2229-516x.140715] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 02/22/2014] [Indexed: 11/17/2022] Open
Abstract
Background: Infected pseudoaneurysm in intravenous (IV) drug abusers is a serious clinical problem, with difficult and controversial management. With existing controversies regarding their optimal management, we present the results of simple ligation and local debridement for treatment of infected pseudoaneurysms. Patients and Methods: Records of 72 consecutive patients with pseudoaneurysms in IV drug abusers over the last 20 years were reviewed retrospectively. Results: Ligation and excision of pseudoaneurysm was done in all patients with delayed revascularization in only two patients. Four patients had amputations because they had gangrenous limbs on presentation. All other patients had healthy limbs at the time of discharge. There were three deaths, two due to sepsis with multiorgan dysfunction and one with hemorrhagic shock. Conclusion: Infected pseudoaneurysm should be managed by simple ligation of involved artery with delayed revascularization, if required.
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Affiliation(s)
- Navdeep Singh Saini
- Department of Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Anil Luther
- Department of Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Amit Mahajan
- Department of Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Allen Joseph
- Department of Surgery, Christian Medical College and Hospital, Ludhiana, Punjab, India
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Abissegue Y, Lyazidi Y, Chtata HT, Taberkant M. Late Complication of a Femoral Monitoring Catheter: A Case of Femoral False Aneurysm Treated Surgically. Ann Vasc Surg 2014; 28:1032.e17-20. [DOI: 10.1016/j.avsg.2013.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 09/11/2013] [Accepted: 09/24/2013] [Indexed: 10/25/2022]
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Kocovski L, Butany J, Nair V. Femoral artery pseudoaneurysm due to Candida albicans in an injection drug user. Cardiovasc Pathol 2013; 23:50-3. [PMID: 24012013 DOI: 10.1016/j.carpath.2013.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/26/2013] [Indexed: 12/18/2022] Open
Abstract
Candida arteritis is an uncommon condition but important to recognize due to the risk of significant morbidity and the difficulty in management of the enduring fungal infection. The authors report a rare case of a man with a femoral artery pseudoaneurysm with persistent Candida albicans infection, as a complication of infective endocarditis. The 23-year-old man, with a history of chronic intravenous drug use and Type I diabetes mellitus, presented with left groin pain, paresthesia of his left foot, and a pulsatile mass in the inguinal region. On imaging, he was found to have a pseudoaneurysm of the left common femoral artery, which later ruptured. Further investigation revealed vegetations on the mitral and aortic valves as well. Initial blood cultures were negative. He underwent multiple surgical interventions including replacement of the mitral and aortic valves and resection of the left common femoral artery with autogenous revascularization. In addition, he was commenced on intravenous antifungal therapy. Postoperatively, he continued to experience significant pain in the left groin and had two episodes of rerupture of the femoral artery that was consequently surgically repaired. Histological examination of the resected valves revealed vegetations with a mixture of fungal elements and bacterial cocci. The femoral artery resection specimens revealed evidence of infectious arteritis and the presence and persistence of C. albicans organisms in subsequent specimens. This case highlights the importance of an accurate diagnosis and aggressive management of fungal mycotic aneurysms in at-risk populations.
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Affiliation(s)
- Linda Kocovski
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada L8N 3Z5.
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Peripheral Arterial Pseudoaneurysms-a 10-Year Clinical Study. Indian J Surg 2013; 77:603-7. [PMID: 26730072 DOI: 10.1007/s12262-013-0939-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 06/17/2013] [Indexed: 10/26/2022] Open
Abstract
Peripheral arterial pseudoaneurysms are quite common in Northern India (Punjab Province) and thus a common presenting complaint of varied etiology. The objective of this study was to evaluate the clinical outcome of patients presenting with peripheral arterial pseudoaneurysms of varied etiology. Retrospective analysis of medical records of patients with diagnosis of peripheral arterial pseudoaneurysm from 1 May 2001 to 30 October 2009 was done. In the prospective period from 1 November 2009 to 30 April 2011, the patients were personally examined by the authors and followed up till discharge from the hospital and subsequently at 2 weeks, 1 month, 3 months, and 6 months postdischarge from the hospital. We studied 50 patients (13 in the prospective group and 37 in the retrospective study group). Intravenous drug abuse (26 cases) followed by trauma (nine cases) was the commonest etiology. Femoral artery was the commonest artery involved (37 cases). A pulsatile mass with localized tenderness was the commonest presentation. All patients underwent surgical treatment with 36 (72 %) patients undergoing ligation and excision of the pseudoaneurysm. Six (12 %) patients underwent revascularization with reverse saphenous vein graft. Five (10 %) patients underwent primary repair, and three (6 %) patients were managed by putting a synthetic ePTFE graft. Postoperative wound infection was seen in 18 (36 %) patients, and 33 (66 %) patients had an uneventful recovery. In pseudoaneurysms, surgical repair at the early instance carries a favorable prognosis. If feasible, reverse saphenous vein grafting is the best conduit for repair. Synthetic vascular graft (ePTFE) can be used in case autologous saphenous vein is not available. Excision and ligation is safe, and we recommend it as the treatment of choice for infected arterial pseudoaneurysms.
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Management of a complicated ruptured infected pseudoaneurysm of the femoral artery in a drug addict. Case Rep Vasc Med 2012; 2012:434768. [PMID: 23227421 PMCID: PMC3514812 DOI: 10.1155/2012/434768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 11/06/2012] [Indexed: 11/18/2022] Open
Abstract
Infected pseudoaneurysm of the femoral artery represents a devastating complication of intravenous drug abuse, especially in the event of rupture. Operative strategy depends upon the extent of arterial injury and the coexistence of infection or sepsis. Options range from simple common femoral artery (CFA) ligation to complex arterial reconstruction with autologous grafts (arterial, venous, or homografts). We report herein the management of a 29-year-old male patient who was urgently admitted with a ruptured pseudoaneurysm of the right CFA, extending well above the inguinal ligament. Multidisciplinary approach with multiple arterial reconstructions and subsequent coverage of the tissue defect with a rectus abdominis musculocutaneous flap transposition was performed.
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Jayaraman S, Richardson D, Conrad M, Eichler C, Schecter W. Mycotic Pseudoaneurysms Due to Injection Drug Use: A Ten-Year Experience. Ann Vasc Surg 2012; 26:819-24. [DOI: 10.1016/j.avsg.2011.11.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 11/16/2011] [Accepted: 11/20/2011] [Indexed: 11/25/2022]
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Cury MVM, de Campos MH, Dos Santos DP. Salmonella-related mycotic pseudoaneurysm of the superficial femoral artery. Int J Surg Case Rep 2011; 3:27-9. [PMID: 22288036 DOI: 10.1016/j.ijscr.2011.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 10/18/2011] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Mycotic pseudoaneurysms of native arteries are rare. Treatment involves arterial excision with or without revascularization. PRESENTATION OF CASE A 49-year-old diabetic man presented with a 4-month history of progressive left mid-thigh pain, associated with a pulsatile mass and fever. Clinically, he appeared to have a mycotic pseudoaneurysm, which was confirmed by computed tomography. The aneurysm was excluded from the circulation by an extra-anatomical bypass graft using autologous vein. CONCLUSION Native arterial mycotic pseudoaneurysms typically occur in immuno-compromised patients. They may be successfully treated using autologous vein bypass. DISCUSSION Arterial infection is associated with immunosuppressive states and Staphylococcus aureus is the most commonly isolated organism in mycotic aneurysms. Also, Escherichia coli, Salmonella sp. and anaerobic species have been identified. Salmonella species are associated with mycotic aneurysms in the abdominal aorta and the use of autogenous vein grafts is the standard treatment for this condition. In lower extremities, autogenous conduits have been already used with good results of patency and freedom from re-infection. Endovascular treatment is a feasible approach in these situations, but there is not reports regarding long term results and this treatment is occasionally associated with prosthesis infection.
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Wu JD, Zheng YH, Choi N, Rui F. Revascularization for Iliac-femoral Artery Pseudoaneurysm with Greater Saphenous Vein. ACTA ACUST UNITED AC 2010; 25:57-60. [DOI: 10.1016/s1001-9294(10)60022-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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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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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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Klonaris C, Katsargyris A, Vasileiou I, Markatis F, Liapis CD, Bastounis E. Hybrid repair of ruptured infected anastomotic femoral pseudoaneurysms: Emergent stent-graft implantation and secondary surgical debridement. J Vasc Surg 2009; 49:938-45. [DOI: 10.1016/j.jvs.2008.10.063] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 10/28/2008] [Accepted: 10/30/2008] [Indexed: 10/21/2022]
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Schneider JR, Oskin SI, Verta MJ. Superficial Femoral Vein Graft Interposition In Situ Repair for Femoral Mycotic Aneurysm. Ann Vasc Surg 2009; 23:147-9. [DOI: 10.1016/j.avsg.2007.12.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Revised: 11/26/2007] [Accepted: 12/04/2007] [Indexed: 11/15/2022]
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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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Salimi J, Shojaeefar A, Khashayar P. Management of infected femoral pseudoaneurysms in intravenous drug abusers: a review of 57 cases. Arch Med Res 2007; 39:120-4. [PMID: 18068005 DOI: 10.1016/j.arcmed.2007.07.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Accepted: 07/08/2007] [Indexed: 11/26/2022]
Abstract
BACKGROUND The present study was carried out to evaluate the clinical characteristics and surgical methods used for the management of infected femoral pseudoaneurysms secondary to illegal drug injections. METHODS Fifty seven consecutive patients who presented with infected pseudoaneurysm of the lower limb and were admitted to the emergency department of Sina Hospital during a 5-year period were enrolled in this study. Surgical methods performed consisted of vein angioplasty, simple ligation of femoral artery, and emergent or delayed revascularization. RESULTS All participating patients were males with a mean age of 36.7 years. Three (5.3%) and two (3.5%) patients underwent primary repair and emergent vascular bypass, respectively; whereas delayed revascularization was performed in only eight (14%) cases. Forty four (77.2%) patients achieved a normal lifestyle without any vascular bypass. Early critical ischemia and late claudication was reported in two (3.5%) and eight (14%) patients, respectively. Other complications such as amputation and mortality were rarely reported. CONCLUSIONS In our study, simple ligation of the external iliac or femoral artery was the most frequent management method for treating infected femoral pseudoaneurysms. Simple ligation of the external iliac or femoral artery seems to be a safe procedure in drug abusers presenting with infected femoral pseudoaneurysms.
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Affiliation(s)
- Javad Salimi
- Subspecialties in Vascular Surgery, Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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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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