Infected false aneurysms in the groin of intravenous drug abusers

Abstract

The hazards of dealing with infected false femoral aneurysms resulting from intra-arterial narcotic injection are highlighted in six patients. Two patients were human immunodeficiency virus positive and three patients were hepatitis B surface antigen positive. Because of these infections exploration of groin swellings as presumed soft tissue abscesses is potentially hazardous without proper proximal vascular control. All patients underwent reconstruction following arterial ligation and five grafts became infected, with life threatening haemorrhage occurring in four patients. Five grafts have subsequently occluded or have been removed without loss of limb viability, although two patients have been regrafted. A high index of suspicion and assessment by a vascular surgeon, with angiography if indicated, is required in any intravenous drug abuser presenting with a groin swelling following injection. Because of the great risk of graft infection, it is suggested that ligation and debridement alone be carried out, with immediate arterial reconstruction only for non-viability.

Infected False Aneurysms of the Limbs Secondary to Chronic Intravenous Drug Abuse: Analysis of Perioperative Considerations and Operative Outcomes

“…These organisms account for most isolates from aneurysmal sac or surrounding tissues in drug addicts with an IFA. [2][3][4][5]8,9,12,[15][16][17]19,21,25 The basic operative plan consisted of Lig-Exc of the IFA, Ld of all necrotic tissue, and extensive drainage of local sepsis, as well as wound cultures, irrespective of the anatomical position of the aneurysm. The feeding vessels were ligated in areas free of infection, far from the infected pseudoaneurysms, to prevent secondary bleeding from disintegration of the infected arterial wall.…”

“…Huebl and Read suggested that the inadvertent intra-arterial or periarterial injection of drugs is the primary cause of femoral false aneurysms. 10 Extravasation of blood and contamination of the subsequent hematoma follows, resulting in breakdown and rupture of the vessel wall, and eventually, an infected pseudoaneurysm 2,4,7,10,11,15,17,18 without surrounding adventitia. Cellulitis or abscess, produced by contaminated needles, can also produce vessel wall rupture if it is close to a vascular structure.…”

“…Cellulitis or abscess, produced by contaminated needles, can also produce vessel wall rupture if it is close to a vascular structure. 4,10,15,22 Chemical arteritis is another possible mechanism of vessel wall injury causing necrosis and subsequent disruption. 2,7 Septic embolization within the arterial lumen from bacterial endocarditis, 3 a common complication in drug addicts, also causes gradual weakening with enlargement of the arterial wall and aneurysm formation.…”

“…drug abuse. [1][2][3][4][5][6][7] Repeated failed attempts to inject preparations of heroin, cocaine, and cannabis into a major upper or lower limb deep vein are likely to cause arterial or vein injury. Among injuries, femoral and brachial artery false aneurysms are being reported with increasing frequency.…”

Acute ligation of the radial and ulnar arteries: A case report and review of literature

“…These infections were a major cause for morbidity and mortality (11). Because there is great risk for infection, it is suggested that ligation and debridement alone be carried out with immediate arterial reconstruction only for nonviability (12).…”