Infected Femoral Artery Pseudoaneurysms Research Articles

Evaluation of Surgical Management of Infected Femoral Artery Pseudoaneurysm in Intravenous Drug Abusers

Evaluation of Surgical Management of Infected Femoral Artery Pseudoaneurysm in Intravenous Drug Abusers

Blind Obturator Bypass-A Scope for Improvisation.

Extra-anatomical femoral bypass in hostile condition such as an infected femoral artery pseudoaneurysm has commonly been performed by tunneling a graft via the obturator foramen. However, the rarity of such cases and very selective indications for the obturator bypass procedure (OBP) has resulted in a paucity of improvisation in this surgery. The aim of this article is to briefly discuss the difficulties faced by our team when recently performing an OBP and to highlight possible innovative approaches by introducing a laparoscope to make the blind OBP safer and more precise.

Patient Outcomes Following Infected Femoral Artery Pseudoaneurysms in Intravenous Drug Users: A Single Centre Four Year Cohort Study

Patient Outcomes Following Infected Femoral Artery Pseudoaneurysms in Intravenous Drug Users: A Single Centre Four Year Cohort Study

A Case of Successful Endovascular Open Stent-graft Treatment for Infected Femoral Artery Pseudoaneurysm According to Intraoperative Judgement

A Case of Successful Endovascular Open Stent-graft Treatment for Infected Femoral Artery Pseudoaneurysm According to Intraoperative Judgement

C52. Infected Femoral Artery Pseudoaneurysm with Klebsiella pneumoniae Bacteremia in Injected Drug Abuser: A Case Report

Abstract Background Injected drug abuse is a significant problem in modern societies today, with increases various vascular complications due to repeated punctures under septic conditions. One of the severe vascular complications is infected pseudoaneurysm. However, no study reported the involvement of Klebsiella pneumonia in infected pseudoaneurysm. Case Summary A 40-year-old homeless man, an injected drug abuser, presented to the emergency department with a severe pain lump in the right groin area since three weeks ago. The hemodynamic was unstable and the laboratory examination revealed severe infection. While ultrasonography was suggesting high suspicion of lymphadenitis in the right groin area, the Doppler ultrasonography was showing a pseudoaneurysm in the right common femoral artery. The blood cultures grew Klebsiella pneumonia ESBL. Patient was planned to be referred to vascular surgery center. Unfortunately, before patient got a referral, his condition worsened with a fall of hemoglobin suggesting rupture of pseudoaneurysm that didn’t improve with resuscitation. Discussion A tender swollen groin in an injected drug abuser should prompt a high index of suspicion for the presence of pseudoaneurysm. When faced with uncertain diagnosis, further investigation with appropriate imaging is warranted. In this case, diagnosis of infected pseudoaneurysm was confirmed due to the co-incidence of septic condition. Surgical management with controlled infection and resuscitation was required, however, it remained a challenge due to the unstable condition and pseudoaneurysm itself that was prone to rupture. In addition, Klebsiella pneumonia ESBL made bacteria resistant to cephalosporins and monobactams.

C52. Infected Femoral Artery Pseudoaneurysm with Klebsiella pneumoniae Bacteremia in Injected Drug Abuser: A Case Report

Abstract Background Injected drug abuse is a significant problem in modern societies today, with increases various vascular complications due to repeated punctures under septic conditions. One of the severe vascular complications is infected pseudoaneurysm. However, no study reported the involvement of Klebsiella pneumonia in infected pseudoaneurysm. Case Summary A 40-year-old homeless man, an injected drug abuser, presented to the emergency department with a severe pain lump in the right groin area since three weeks ago. The hemodynamic was unstable and the laboratory examination revealed severe infection. While ultrasonography was suggesting high suspicion of lymphadenitis in the right groin area, the Doppler ultrasonography was showing a pseudoaneurysm in the right common femoral artery. The blood cultures grew Klebsiella pneumonia ESBL. Patient was planned to be referred to vascular surgery center. Unfortunately, before patient got a referral, his condition worsened with a fall of hemoglobin suggesting rupture of pseudoaneurysm that didn’t improve with resuscitation. Discussion A tender swollen groin in an injected drug abuser should prompt a high index of suspicion for the presence of pseudoaneurysm. When faced with uncertain diagnosis, further investigation with appropriate imaging is warranted. In this case, diagnosis of infected pseudoaneurysm was confirmed due to the co-incidence of septic condition. Surgical management with controlled infection and resuscitation was required, however, it remained a challenge due to the unstable condition and pseudoaneurysm itself that was prone to rupture. In addition, Klebsiella pneumonia ESBL made bacteria resistant to cephalosporins and monobactams.

Outcomes of Covered Stents With Vacuum Sealing Drainage For Treatment of Infected Femoral Pseudoaneurysms in Intravenous Drug Addicts

For treatment of infected femoral artery pseudoaneurysms (IFAPs) with the covered stent, debridement technique is important but frequently ignored. Our study aims to review our experience and outcomes of patients undergoing covered stents placement and debridement with vacuum sealing drainage (VSD). This study retrospectively analyzed 41 intravenous drug addicts with IFAP who received covered stent implantation and debridement with VSD from January 2015 to December 2020. The diagnosis was based on the previous history of local injection and the presence of pulsatile mass at the injection site. All cases were confirmed by CT angiography (CTA), ultrasound, or digital subtraction angiography (DSA). Technical success, time of wound care, and clinical outcomes were evaluated. Technical success was achieved in all patients. The interval from diagnosis to treatment was 26 ± 11 hours. The time of continuous drainage with VSD was 18.79 ± 6.56 days. 38 patients (92.68%) with fresh granulation tissue were sutured and discharged from the hospital. Stents in 31(91.18%) of 34 cases were patent during follow-ups. Three patients had stent occlusion caused by thrombosis, and two of them were complicated with stent infection. The two infectious stents were removed and the femoral arteries were ligated. One of them received open-surgical reconstruction with the great saphenous because of claudication. Two patients were admitted to the hospital for rebleeding caused by drug abuse relapse. Covered stents placement is convenient and rapid to control massive hemorrhage in IFAPs of intravenous drug abuse. Early debridement of infected tissue with continued VSD may shorten the time of wound care and make the incidence of stent infection relatively low. Meanwhile, the patency in a short time follow-up is acceptable. These results indicate that covered stents implantation with VSD may be a safe, effective, and feasible measure for the treatment of IFAPs.

INCIDENCE AND DETERMINANTS OF LOWER LIMB SALVAGE FOLLOWING ARTERIAL LIGATION IN INFECTED PSEUDOANEURYSM IN INTRAVENOUS DRUG ABUSERS

Background: Infected femoral artery pseudoaneurysms (IFAPs) in Intravenous drug abusers (IVDAs) are very common nowadays with increasing incidence and controversial management strategy with little data about correlation between IFAPs criteria and limb outcome.Aim of the work: to estimate incidenceand determinants of limb salvage post arterial ligation in patients with infected pseudoaneurysms.Patients and Methods: Prospective cohortwith18 months follow up of 40 IVDA patients presented with groin pseudoaneurysms to estimate incidence and determinants of Lower Limb salvage following Arterial Ligation.Results:Duration of Intravenous (IV) addiction ranged from half a year to 30 years and affected groin use ranged from half a year to 10 years and duration of symptoms ranged from 1 to 6 weeks. Symptoms ranged between swelling in 13 cases (32.5%), pulsating mass in 12 cases (30%) and hemorrhage in 15 cases (37.5 %). DVT found in 31 cases (77.5 %). Incidence of limb salvage post arterial ligation is 75%(N 30), threatened limbs found in 25% of cases (N 10). Amputation required in 15%(N 6) and bypass in 12.5%(N 5) bypass followed by amputation in one patient. Primary patency of all constructed bypasses is 6 months for 80% (N 4) and 3 months for 20% (N 1).Viral markers showed 33 patients were HCV +ve (82.5%), 8 patients HBV +ve (20%), 9 patients HIV +ve (22.5%). There was statistically significant difference between both groups as regard duration of affected groin use, duration of symptoms, nature of presenting symptom, Pre and immediate post-operative ABI and percent of reduction between both and Level of ligation are determinants of limb salvageConclusion: Ligation and debridement with selective revascularization strategy is a safe option in IFAPs management.Incidence of limb salvage following arterial ligation is 75%. Duration of affected groin use, duration of symptoms, nature of presenting symptom, Pre and immediate post-operative ABI and percent of reduction between both and Level of ligation are determinants of limb salvage.

EXTERNAL ILIAC ARTERY LIGATION AND LOCAL DEBRIDEMENT. A SAFE TREATMENT OPTION FOR INFECTED FEMORAL ARTERY PSEUDOANEURYSM IN INTRAVENOUS DRUG ABUSERS

Introduction: “Mycotic aneurysms are defined as a localized, irreversible dilationof an artery due to destruction of the vessel wall by infection.” Intravenous (IV) drug abuse isan increasing social and health problem. Repeated punctures under septic conditions alongwith needle sharing habits among IV drug abusers result in various vascular complications.In addition, patients who present with these complications frequently have viral infections,which are hazardous to healthcare workers. Objectives: With these existing controversies ofoptimal surgical management of infected femoral artery pseudo aneurysm, we reviewed oursurgical technique used for their treatment and their clinical outcome, in a population of IVdrug abusers of Rahim Yar Khan. Study Design: Retrospective, descriptive study. Setting:Sheikh Zayed Medical College/ Hospital Rahim Yar Khan. Period: 2 years from 1-1-2015 to 31-12-2016. Material & Methods: Total 10 patients were included in this study. All patients weremanaged and operated in emergency ward. In all the patients we performed first external iliacligation and then excision of the sac and debridement of the wound. The protocol of this studyhas been approved by the ethical committee of the hospital. Results: In this 2 years study,10 patients were managed. Mean age was 22.5 years and age range from 18-28 years. Allpatients were young males and belong to low socioeconomic status. The duration of IV drugabuse was 2-3 years. A self-injection was the commonest mode of injection. All the infectedfemoral pseudo aneurysms were on the right side. 5 patients were hepatitis C virus (HCV) +veand 4 patients were hepatitis B surface antigen (HbsAg) positive. Only one patient was humanimmunodeficiency virus (HIV) positive. Five patients presented with oozing pulsating mass and5 patients with infected pulsatile mass. Right leg was survived in all the patients. There was noamputation. Conclusion: Ligation of the external iliac artery first then excision and debridementof the infected femoral artery pseudo aneurysms seems to be a safe procedure in IV drugabusers with low morbidity and no mortality. There was no amputation of the limb.

FEMORAL ARTERY PSEUDOANEURYSM

Introduction: “Mycotic aneurysms are defined as a localized, irreversible dilationof an artery due to destruction of the vessel wall by infection.” Intravenous (IV) drug abuse isan increasing social and health problem. Repeated punctures under septic conditions alongwith needle sharing habits among IV drug abusers result in various vascular complications.In addition, patients who present with these complications frequently have viral infections,which are hazardous to healthcare workers. Objectives: With these existing controversies ofoptimal surgical management of infected femoral artery pseudo aneurysm, we reviewed oursurgical technique used for their treatment and their clinical outcome, in a population of IVdrug abusers of Rahim Yar Khan. Study Design: Retrospective, descriptive study. Setting:Sheikh Zayed Medical College/ Hospital Rahim Yar Khan. Period: 2 years from 1-1-2015 to 31-12-2016. Material & Methods: Total 10 patients were included in this study. All patients weremanaged and operated in emergency ward. In all the patients we performed first external iliacligation and then excision of the sac and debridement of the wound. The protocol of this studyhas been approved by the ethical committee of the hospital. Results: In this 2 years study,10 patients were managed. Mean age was 22.5 years and age range from 18-28 years. Allpatients were young males and belong to low socioeconomic status. The duration of IV drugabuse was 2-3 years. A self-injection was the commonest mode of injection. All the infectedfemoral pseudo aneurysms were on the right side. 5 patients were hepatitis C virus (HCV) +veand 4 patients were hepatitis B surface antigen (HbsAg) positive. Only one patient was humanimmunodeficiency virus (HIV) positive. Five patients presented with oozing pulsating mass and5 patients with infected pulsatile mass. Right leg was survived in all the patients. There was noamputation. Conclusion: Ligation of the external iliac artery first then excision and debridementof the infected femoral artery pseudo aneurysms seems to be a safe procedure in IV drugabusers with low morbidity and no mortality. There was no amputation of the limb.

Surgical Management of the Infected Femoral Pseudoaneurysms In Intravenous Drug Addicts

Background: Vascular system complications are an ongoing hazard of intravenous drug abuse. Patients and Method: This is a prospective study. The study was conducted on twenty patients who were presented at AL Hussein University Hospital in Cairo with infected femoral artery pseudoaneurysm over a period of eight months from Nov 2017 to July 2018. The inpatient medical charts were reviewed. Data were obtained on their demographic, clinical, management and outcome parameters. Result: Among the twenty intravenous drug users presenting with infected femoral artery pseudoaneurysms, (16) of the patients (80%) were seropositive for HCV. All were operated, with (5%) mortality. Primary ligation and debridement was the technique used almost exclusively (75%). One patient was managed by primary reconstruction by direct in-situ repair. Four patients were managed by primary revascularization through exta-anatomical bypass. Mean follow up period was three months. Conclusion: Ligation and debridement appears to be a simple, safe and effective procedure in infected pseudoaneurysms in IV drug users.

Surgical Management of the Infected Femoral Pseudoaneurysms In Intravenous Drug Addicts

Background: Vascular system complications are an ongoing hazard of intravenous drug abuse. Patients and Method: This is a prospective study. The study was conducted on twenty patients who were presented at AL Hussein University Hospital in Cairo with infected femoral artery pseudoaneurysm over a period of eight months from Nov 2017 to July 2018. The inpatient medical charts were reviewed. Data were obtained on their demographic, clinical, management and outcome parameters. Result: Among the twenty intravenous drug users presenting with infected femoral artery pseudoaneurysms, (16) of the patients (80%) were seropositive for HCV. All were operated, with (5%) mortality. Primary ligation and debridement was the technique used almost exclusively (75%). One patient was managed by primary reconstruction by direct in-situ repair. Four patients were managed by primary revascularization through exta-anatomical bypass. Mean follow up period was three months. Conclusion: Ligation and debridement appears to be a simple, safe and effective procedure in infected pseudoaneurysms in IV drug users.

Ligation Without Revascularisation is Safe and Effective in the Management of Infected Femoral Artery Pseudoaneurysms Secondary to Intravenous Drug Abuse

Ligation Without Revascularisation is Safe and Effective in the Management of Infected Femoral Artery Pseudoaneurysms Secondary to Intravenous Drug Abuse

Percutaneous Treatment of a Giant Infected Femoral Artery Pseudoaneurysm

Femoral artery pseudoaneurysm due to infection of a vascular closure device is rare and potentially life threatening. Surgical repair of the blood vessel is the preferred therapy. We describe such a patient who was successfully treated percutaneously by implantation of a stent graft. A 60-year-old

Obturator Bypass for Recurrent Infected Femoral Artery Pseudoaneurysm

Obturator Bypass for Recurrent Infected Femoral Artery Pseudoaneurysm

The Treatment of Infected Femoral Artery Pseudoaneurysms Secondary to Drug Abuse: 11 Years of Experience at a Single Institution

The purpose of our study is to analyze the methods of treating infected femoral artery pseudoaneurysms (IFAPs), and also to identify the most appropriate method, especially for patients with a long history of drug abuse. A retrospective chart review of 88 consecutive IFAPs secondary to drug abuse between 2003 and 2014 was performed. Outpatient clinic charts were reviewed, as well as inpatient and anesthesia records. All patients had undergone a computer tomography angiography or contrast computer tomography to confirm their diagnosis. Routine blood tests were performed. The treatment methods included common femoral artery ligation (CFA) along with local debridement and drainage, direct oversewing, and amputation. A clamping test of the distal external iliac artery (EIA) or the common femoral artery was performed after vessel isolation, during which the oxygen saturation of the blood at the end of the affected limb was examined with a continuous pulse oximeter. Skin samples from affected limbs were tested with hematoxylin and eosin (HE) stain. There were a total of 88 patients, of which 79 and 9 came from emergency and outpatient, respectively. Acute hemorrhage at the injection site, pulsatile mass, septic syndrome, and necrosis were present in 65, 14, 8, and 1 patients, respectively. All patients experienced groin pain. Thigh or leg swelling was present in 63 patients. The drug injection history was a mean 6.9±4.1years. Seventy-four patients presented with anemia and 75 patients presented with hypoproteinemia. Hepatitis B, hepatitis C, syphilis, and HIV were found in 42, 57, 12, and 2 patients, respectively. One patient gave up the treatment. One patient was treated by amputation along with CFA ligation and local debridement because the limb was necrotic on admission. Three patients with short drug injection abuse history and local slight infection were treated by direct oversewing. Eighty-three patients, of which 27 had a drug injection history shorter than 5 years and 56 patients longer than 5 years, were treated by CFA ligation and local debridement. All patients' oxygen saturation of the affected limbs was higher than 90% after distal EIA clamping test and ligation, except the amputation patient. None of these required amputation. One patient, whose injection history was only half a year, underwent an operation for acute ischemic performance. Forty patients had differing degrees of lymph extravasations and were treated by injecting 70% methylated amine diatrizoate. HE stain showed that there were an abundant of microcirculation vessels in IFAP patients. The mean follow-up period was mean (26±14) months from 3 months to 61months. In the group with a history shorter than 5 years, 10 patients had mild claudication in the first 3 months and then relieved from 6 months. However, in patients with a history longer than 5 years, no case presented claudication. Many of them admitted to drug abuse after surgery and rehabilitation. The appropriate and tolerated treatment for most IFAP is arterial ligation, particularly in patients with an injected drug history longer than 5 years. Primary repair may be adopted for special IFAP patients with short drug injection history and limit infection to avoid severe ischemia complication. Medical staff should take strict precautions and protection measures.

Infected Pseudoaneurysm of the Superficial Femoral Artery

Infected Pseudoaneurysm of the Superficial Femoral Artery

Treatment of Infected Pseudoaneurysm of Femoral Artery after Vascular Closure Device Deployment: A Practical Solution

Like other invasive procedures, percutaneous coronary interventions are associated with complications. Most common access site for these procedures is common femoral artery. Complications such as groin and retroperitoneal hematoma can be encountered as well as pseudoaneurysms, arteriovenous fistulas, acute arterial occlusion, and infection. When infected pseudoaneurysm occurs, surgical treatment can be extremely difficult. We present a case of the patient in whom infected pseudoaneurysm of common femoral artery developed after percutaneous coronary intervention and was successfully treated by surgical excision and autoarterial graft insertion.

Femoral Artery Ligation as Treatment for Infected Pseudo-Aneurysms, Secondary to Drug Injection

Objective: Parenteral drug injection can cause a wide range of vascular complications, from simple vascular irritation to severe infections, thrombosis and pseudo-aneurysm formation. These latter complications may become limb-or even life-threatening.Patients and methods: This is a retrospective descriptive study of cases admitted to the Shohada Medical Centre, between March 1990 and June 2005.Results: A total of 134 drug addicts presenting with infected femoral artery pseudo-aneurysms were treated. All patients had their femoral arteries ligated. Limbs of all 134 patients were saved.Conclusions: Ligating the femoral artery is an effective way to treat femoral artery pseudo-aneurysm, secondary to drug abuse.

Tolerable Hemodynamic Changes after Femoral Artery Ligation for the Treatment of Infected Femoral Artery Pseudoaneurysm

We analyzed the hemodynamic changes induced by femoral artery ligation with concomitant thrombectomy in intravenous drug abusers with infected femoral artery pseudoaneurysm (IFAP) and their clinical significance. Between January 2000 and November 2007, a total of 55 patients presented to our clinic with IFAP. Among these patients, 54 were treated by femoral artery ligation with concomitant thrombectomy. Open collateral circulations were assessed by intraoperative angiography, including detection of mean artery pressure (MAP) of back-flow from the profunda femoris artery and the superficial femoral artery after operation. Patients were followed up for 3-72 months (mean 35). The data were then subjected to statistical analysis. Preoperative death occurred in one patient due to acute onset of drug addiction in the ward. Preoperatively, massive necrosis developed in the left limb of the only patient with bilateral IFAPs. All 54 patients underwent femoral artery ligation with concomitant thrombectomy, including nine cases of ligation of the external iliac artery and one case of above-knee limb amputation. All wounds were completely healed within 3 months. Six late deaths (11.1%), resulting solely from refractory drug addiction, were observed during the follow-up period, of which two occurred 2 years, one 4 years, and three 5 years postoperatively. No toe amputations were noted during the follow-up period. Fourteen patients (25.9%) developed intermittent claudication. One postoperative limb was lost. Of all 54 patients, 38 were subjected to collateral circulation assessment by intraoperative angiography. Collateral circulations were found well open in a baseline path with four stations down to the distal lower limbs of all assessed patients. Four preferred types of iliac-femoral collaterals were defined. Postoperatively, compared to the external iliac artery, the MAP levels of back-flow from the profunda femoris artery and the superficial femoral artery significantly dropped to 43.89+/-2.75 and 18.08+/-2.76 mm Hg, respectively. As a result of femoral artery ligation without reconstruction, well open collateral circulations and acceptable distal arterial runoff blood are seen, which suggests that this procedure is a reliable alternative to the emergent treatment of IFAPs in drug addicts. However, arterial reconstruction may be used as a backup approach if necessary during observation.