Abstract
ObjectiveTo determine the outcomes of the ligation and excision of brachial artery pseudoaneurysm in IV drug abusers without revascularization. MethodologyThis retrospective observational study was conducted at the vascular surgery department Shaheed Muhtarma Benazir Bhutto trauma center Karachi from January 2019 to June 2020. All the patients with a history of intravenous drug abuse presented with pulsatile mass at or near cubital fossa, diagnosed as pseudoaneurysm, age ranging from 18-70 years, and of either gender were included in the study. Patients with pseudo-aneurysm secondary to trauma, hemodialysis, arteriovenous fistula, location other than cubital fossa, and whom primary revascularization was performed were excluded. The recorded data entered and analyzed using SPSS 20.0 (IBM Corp., Armonk, NY).ResultsA total of 20 intravenous drug addicts were included in the study. The mean age was of 31.10 ± 7.80 years, and the mean duration of addiction was 2.24 ± 1.16 years. The right arm is affected in almost two-thirds of patients. The most common presentation in the emergency department was ruptured pseudo-aneurysm with bleeding (65%), followed by oozing with pulsatile mass (30%), and infected pulsatile mass (5%). The outcome was Limb salvage (100%), and none of the patients had developed threatened ischemia of the arm or required amputation.ConclusionThe ligation and excision of the pseudo-aneurysm, without revascularization, is a safe and effective treatment option for the management of pseudoaneurysm of the brachial artery secondary to intravenous drug addiction.
Highlights
The use of illicit drugs in society is at a surge, and its impact on our youth and skilled people is problematic
A pseudoaneurysm can distinguish from a true aneurysm by lacking all three vessel walls and from waveform in duplex Doppler ultrasound [7,8]
The data collection included all intravenous drug abusers with brachial artery pseudo-aneurysm presented in our emergency department from January 2019 to June 2020
Summary
The use of illicit drugs in society is at a surge, and its impact on our youth and skilled people is problematic. A detailed report by the United Nations Office on Drugs and Crime (UNODC) revealed an estimate of 35 million drug-affected people globally [1]. Death among intravenous drug addicts has an association with overdosage, suicide, trauma, and infections like HIV (human immunodeficiency virus) and Hep-C (hepatitis C) [3] as well as various vascular complications [4]. Arterial Pseudoaneurysm (False Aneurysm) differs from true aneurysms. They lack all three normal elements of the arterial wall, a rare complication (a potential limb and life-threatening). A pseudoaneurysm can distinguish from a true aneurysm by lacking all three vessel walls and from waveform in duplex Doppler ultrasound [7,8]
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