MYCOTIC FEMORAL PSEUDOANEURYSMS FROM INTRAVENOUS DRUG ABUSE
Abstract
Background. Parenteral drug abuse is the most common cause of infected femoral artery pseudoaneurysms (IFAP). This complication of intravenous drug abuse is not only limb threatening but can also be life threatening. The management of the IFAP is difficult and controversial. Generally speaking, ligation and excision of the pseudoaneurysm without revascularization is accepted procedure in majority of the patients. However it is not regarded as an appropriate procedure for cases where the high probability of amputation is expected from acute interruption of the femoral artery flow.
Patients, methods and results. We present three cases of young (average 20 years, range 18–24) patients with IFAP, in which a primary reconstruction was performed due to absence of doppler signal over pedal arteries after ligation of common femoral artery. In two of them complications in form of haemorrhage and repeated infection developed in late postoperative period. The first one, had an excision and ligation while the second one had a reconstruction made by means of a silver impregnated dacron prosthesis. None of the patients required an amputation.
Conclusions. Overall prognosis and prognosis of the reconstruction in parenteral drug abuse patients is uncertain because there is a high incidence of postoperative drug injection despite aggressive drug rehabilitation.
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References
Geelhoed GW, Joseph WL. Surgical sequelae of drug abuse. Surg Gynecol Obstet 1974; 139: 749–55.
Anderson CB, Butcher HR, Ballinger WF. Mycotic aneurysm of the drug addict. Arch Surg 1974; 109: 712–7.
Johnson JR, Ledgerwodd AM, Lucas CE. Mycotic aneurysm: a new concept in therapy. Arch Surg 1983; 118: 577–82.
Albert CW, Ting MD, Stephen WK, Cheng MD. Femoral pseudoaneurysms in drug addicts. World J Surg 1997; 21: 783–7.
Tsao JW, Marder SR, Goldstone J et al. Presentation, diagnosis and management of arterial mycotic pseudoaneurysms in injection drug users. Ann Vasc Surg 2002; 16: 652–62.
Willoughby CP, Evans E, Stoker TAM, Gabriel R. Arterial hemorrhage in a drug addict. Br Med J 1984; 2: 307–8.
Padberg F, Hobson R, Bing L et al. Femoral pseudoaneurysm from drugs of abuse: ligation or reconstruction? J Vasc Surg 1992; 15: 642–8.
Reddy DJ, Smith RF, Elliot JP et al. Infected femoral artery false aneurysms in drug addicts: evolution of selective vascular reconstruction. J Vasc Surg 1986; 3: 718–24.
Patel KR, Semel L, Clauss RH. Routine revascularization with resection of infected femoral pseudoaneurysm from substance of abuse. J Vasc Surg 1988; 8: 321–8.
Arora S, Weber MA, Fox CJ et al. Common femoral artery ligation and local deridement: a safe treatment for infected femoral artery pseudoaneurysms. J Vasc Surg 2001; 33: 990–3.
Frezza EE, Mezghebe H. Indications and complications of arterial cathether use in surgical or medical intensive care units: analysis of 4932 patients. Am Surgeon 1998; 64: 127–31.
Grotemeyer D, Graupe F, Mackrodt HG, Stock W. Salmonella enteritidis infiziertes falsches Aneurysma der Arteria femoralis superficialis bei einem HIV-seropositiven Patienten. Chirurg 1998; 69: 204–7.
Woodburn KR, Murie JA. Vascular complications of injecting drug misuse. Br J Surg 1996; 83: 1929–334.
Crane LR, Levine DP, Zervos MJ, Cummings G. Bacteremia in narcotis addicts at the Detroit Medical centre. I. Microbiology, epidemiology, risk factors, and empiric therapy. Rev Infect Dis 1986; 8: 364–73.
DeBakey ME, Simeone F. Battle injuries of the arteries in World War II: an analysis of 2471 cases. Ann Surg 1946; 123: 534–79.
Reddy DJ, Shepard AD, Evans JR et al. Management of infected aorto iliac aneurysms. Arch Surg 1991; 126: 873–9.
Simmons MM, Cupp MJ. Use and abuse of flunitrazepam. Ann of Pharmacother 1998; 32: 117–9.
Woods JH, Winger G. Abuse liability of flunitrazepam. J Clin Psychopharmacol 1997; 17: Suppl 2: 1–57.
Stone MH, Stone DH, MacGregor HA. Anatomical distribution of soft tissue sepsis sites in intravenous drug misusers attending an accident and emergency department. Br J Addict 1990; 85: 1495–6.
Kaiser MM, Kujath P, Müller G, Bruch HP. Bechandlungsstrategien inguinaler Spritzenabscesse und ihrer Komplikationen. Chirurg 1997; 68: 1029–34.
Schulz S, Aksü A, Igde A, Hengstmann J. Akute Ischämie des beines bei einem Drogenabhängigen. VASA 2002; 31: 57–61.
Joist A, Tibesko CO, Neuber M et al. Gangrene of the fingers caused by accidental injection of diazepam. Dtsch Med Wochenschr 1999; 124: 755– 8.
Wedderburn A, Carter P, Morris G. An acutely painful leg. Postgrad Med J 1997; 73 (860): 359–60.
Cheng SW, Fok M, Wong J. Infected femoral pseudoaneurysm in intra-venous drug abusers. Br J Surg 1992; 79: 510–2.
Haiart DC, Andrade B, Murie JA. Gas gangrene following intraarterial injection of oral medication in drug abuser. Eur J Vasc Surg 1992; 6: 565–6.
Cooper JC, Griffiths AB, Jones RB, Raferty AT. Accidental intraarterial injection in drug addicts. Eur J Vasc Surg 1992; 6: 430–3.
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