Pseudoaneurysms In Intravenous Drug Abusers Research Articles

Management of Brachial Artery Pseudoaneurysms in Intravenous Drug Abusers

Aim: To assess the outcomes of ligation and excision of brachial artery pseudoaneurysm without revascularization in IV drugs users. Place & duration of study: From Jan 2021 to Jan 2022 at the department of Surgery of Doctors Hospital & Medical Centre Lahore. Methodology: A retrospective observational study was conducted at the surgery department of Doctors Hospital & Medical Centre Lahore for 1 year. Intravenous drug abusers, aged between 18-65 years diagnosed with brachial artery pseudoaneurysm were included in the study whereas pseudoaneurysm was caused due to arteriovenous fistula, hemodialysis, and trauma or in patients who had undergone revascularization were excluded from the study. The data were processed using SPSS 20.0. Results: A total of 15 intravenous drug users were enrolled in the study. The mean age of the participants was 33.4±5.4 years, and the mean period of addiction was 1.9±2.5 years. Majority of patients (65%) presented with an affected right arm. The most common presentations were: bleeding pseudoaneurysm (73.3%), oozing pulsatile mass (20%), and infected pulsatile mass (6.6%). Following the intervention, limb salvage was achieved in all patients. Ischemia was reported in none of the patients. Conclusion: The excision and ligation of the pseudoaneurysm can be an effective treatment option for the pseudoaneurysm of a brachial artery caused due to drug addiction. Keywords: The brachial artery, pseudoaneurysm, intravenous drug users, drug addiction

Infected femoral pseudoaneurysms in intravenous drug abusers: a decade of experience from a Singapore tertiary centre.

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. 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. 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. 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.

Management of Brachial Artery Pseudoaneurysms in Intravenous Drug Abusers

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.

Endocarditis associated pseudoaneurysm in intravenous drug abuser.

Endocarditis associated pseudoaneurysm in intravenous drug abuser.

Predictors of Limb Outcome Following Arterial Ligation of Infected Femoral Pseudoaneurysms in Drug Abusers

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. Prospective study. 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. 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. 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.

Brachial artery pseudo-aneurysm in intravenous drug abuser: a rare case report

Brachial artery pseudo-aneurysm (BAP) is a rare entity because pseudo-aneurysms are common in lower limbs.1 Usual causes of BAP are humeral fractures, iatrogenic causes (repeated punctures for sample collection, following construction of Brachio-cephalic fistula) or some genetic causes like Ehler Danlos syndrome (EDS). This case has been reported to highlight the importance of considering all the differential diagnosis while evaluation of an upper limb swelling especially in the cubital fossa and due consideration of history of any IV drug abuse.

Infected pseudoaneurysms in intravenous drug abusers: Ligation or reconstruction?

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.

On The Management of Mycotic Femoral Pseudoaneurysms in Intravenous Drug Abusers

To the Editor: Peirce and colleagues reported the results of their 5-year experience with the management of mycotic femoral pseudoaneurysms in intravenous drug abusers. Regarding this article, we would like to mention some points. These aneurysmal abscesses attributable to repeated nonsterile punctures aiming at locating easy peripheral venous access are increasing the potential risk of sepsis, bleeding, limb loss, and even death. Although ultrasound-guided thrombin injection was advised as the first-line treatment for postcatheterization pseudoaneurysms of the femoral artery, it is rarely possible for infected pseudo aneurysms in intravenous drug abusers. There is still a controversy as to the necessity, timing, and method of revascularization in intravenous drug abusers; however, the local debridement of all necrotic tissues and the drainage of the associated abscess remain the first treatment steps for the effective control of infection and sepsis. It would therefore be interesting to know why ultrasound-guided thrombin injection is selected by Peirce et al. for managing femoral pseudoaneurysms in intravenous drug abusers. Similarly, 74 patients (100% male, with the mean age of 34.8 years) with infected femoral pseudoaneurysms were treated in our center at Sina Hospital during a 7-year period (2000 to 2007). The treatment included the administration of systemic antibiotics and the drainage of the abscess or debridement of the infected tissue. Surgical methods performed for controlling bleeding and limb ischemia consisted of (1) the simple ligation of the external iliac or femoral artery alone in 79.7% of the cases or together with (2) emergent bypass in 2.7% cases or delayed bypass in 13.5% of cases and (3) primary repair in 4.1% of the patients. Simple ligation of the external iliac or femoral artery with the drainage and debridement of the infected collection was a safe procedure for treating infected femoral pseudoaneurysms and for the eradication of sepsis. Unlike in the study of Peirce et al., we did not use thrombin injection as a therapeutic approach for these patients.

Surgical Management of Infected Pseudoaneurysms in Intravenous Drug Abusers: Single Institution Experience and a Proposed Algorithm

Vascular complications from intravenous drug abuse pose significant challenges to vascular surgeons. No formalized policies have been reached on surgical management of the resultant infected pseudoaneurysm. A retrospective review of all patients who underwent surgery for pseudoaneurysms due to chronic intravenous drug abuse from July 2005 to February 2008 was performed. A total of 15 patients with infected pseudoaneurysms from chronic intravenous drug abuse were operated on during the study period. The sites of involvement were restricted to the femoral (86.7%) and brachial (13.3%) areas. The drug involved was buprenorphine (Subutex) in all cases. Pain over the limb swelling (100%), pulsatility (60%), and symptoms suggestive of septicemia (46.7%) were the most common symptoms. Staphylococcus aureus was present in 93.3%. Diagnosis was achieved clinically in 26.7%, by duplex ultrasonography in 60.0%, and by computed tomography (CT) angiography in 13.3%. In the two patients with brachial pseudoaneurysms, the brachial artery was ligated in one, and a basilic vein patch was used in the other. In the 13 patients with femoral pseudoaneurysms, the pseudoaneurysm was ligated and excised in 8 (61.5%), and immediate reconstructive bypass surgery was performed in 5 (38.5%). Two patients had critical ischemia after ligation and required reconstructive bypass surgery a few weeks later. Postoperative complications included claudication, digital gangrene, localized wound infection, and rebleeding. There was no associated mortality. Pseudoaneurysm from intravenous drug abuse continues to pose significant challenges to surgeons worldwide, ranging from an accurate diagnosis to the choice of surgery. The aims of surgery must be to achieve adequate débridement and control infection and hemorrhage. Any associated postoperative complications must be identified and dealt with.

The Management of Mycotic Femoral Pseudoaneurysms in Intravenous Drug Abusers

Mycotic femoral pseudoaneurysms, particularly in the drug-abusing population, pose a difficult problem to the vascular surgeon. Management ranges from ligation with debridement to extra-anatomical bypass. This study reviewed the management of mycotic femoral pseudoaneurysms presenting in intravenous drug abusers to an inner city tertiary referral center. Between 2001 and 2006, 11 cases presenting in nine patients were treated. The mean age was 30.7 years with a male-to-female ratio of 1:2. Eight patients had a positive viral status for the human immunodeficiency virus and/or hepatitis C. Two patients re-presented with a contralateral pseudoaneurysm. A combination of groin pain and swelling was the most common presentation. Two patients presented with significant hemorrhage. The diagnosis was confirmed by ultrasound in the majority of cases. Nine cases were managed with arterial ligation and debridement of the necrotic tissue. The two remaining cases were managed with ultrasound-guided thrombin injection and arterial puncture closure. On follow-up, one patient required a below-knee amputation following reinjection into the postoperative wound site. One further patient underwent a fifth metatarsal amputation due to ischemia. Ligation and debridement are well tolerated in the majority of drug-abusing patients diagnosed with mycotic femoral pseudoaneurysms.

Management of Infected Femoral Pseudoaneurysms in Intravenous Drug Abusers: A Review of 57 Cases

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. 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. 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. 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.

Surgical Approach to Vascular Complications of Intravenous Drug Abuse

Objective: To assess the complications related to intravenous drug abuse. Design: Prospective study. Methods: Intravenous drug abusers (IVDAs) with vascular complications were assessed. Results: Sixty-two patients presented with swelling and tenderness in the groin, and 3 patients with similar lesions in the cubital fossa. Infected pseudoaneurysms and deep vein thrombosis (DVTs) were diagnosed in 41 and 31 patients respectively (27 patients had both lesions). In patients with infected pseudoaneurysms, 9 patients underwent excision with early revascularization and 32 patients underwent ligation without revascularization. For all patients with femoral vein thrombosis ligation and excision was performed. 4 patients with pure DVTs were managed conservatively. Disabling claudication occurred in 6 patients. Four of them underwent late revascularization with an acceptable outcome. Conclusions: Ligation without revascularization is the appropriate treatment of infected pseudoaneurysms in IVDAs. Late revascularization is of great importance in patients with disabling claudication after treatment of addiction. Pure septic DVTs can be managed conservatively.