Infected pseudoaneurysms in intravenous drug abusers: Ligation or reconstruction?

Abstract

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.

Outcomes of Ligation without Revascularization in Pseudoaneurysms of Peripheral Arteries in Intravenous Drug Users

“…In addition, there is limited availability of autologous vein graft and revascularization is associated with high incidence of complications in IV drug users. 7 Therefore, many centers have adopted the strategy of no revascularisation or selective revascularisation. 7,8 In this study, we describe the presentation and management outcomes of 15 consecutive patients presenting with peripheral artery pseudoaneurysm from IV drug abuse at our centre in eastern Nepal.…”

Management options in the treatment of femoral pseudoaneurysms secondary to intravenous drug abuse: A case series

“…The use of an autologous graft may be most appropriately reserved for patients who are haemodynamically stable and able to have sufficient pre-operative investigations and optimisation with the literature suggesting an extra-anatomical bypass to confer the best results in this cohort. Similarly, ligation of the common femoral artery without revascularisation can be both safe and effective as many patients will avoid an amputation and most will be without claudication symptoms [4] , [6] , [22] .…”

A staged, endovascular approach to treat a ruptured external iliac artery mycotic pseudoaneurysm in an intravenous drug user: A case report

“…Traditionally, treatment of mycotic pseudoaneurysms in the IVDU population has focussed on arterial ligation but this renders the (often young) patient-group vulnerable to on-going problems such as claudication or ischaemia requiring major-limb amputation [3] , [4] . In the endovascular era, hybrid procedures with the use of endoluminal devices to achieve haemorrhagic control is a useful adjunct but harbours the significant risk of stent-graft infection requiring delayed excision with or without arterial reconstruction [7] , [8] .…”

“…Mycotic pseudoaneurysm formation and subsequent rupture in intravenous drug users (IVDU) can be potentially devastating to patients, or result in death [1] , [2] . Various treatment strategies for haemorrhage control have been reported with most advocating arterial ligation [3] , [4] . Other strategies include arterial ligation with immediate arterial reconstruction or as we report, endovascular stent-graft insertion.…”