Surgical Approach to Vascular Complications of Intravenous Drug Abuse

Yegane, Rooh-Allah; Salehi, Nour-Allah; Ghaseminegad, A.; Bahrami, Faranak; Bashashati, Mohammad; Ahmadi, Mehran Arab; Hojjati, Mohammad Reza

doi:10.1016/j.ejvs.2006.02.014

Cited by 28 publications

(8 citation statements)

References 18 publications

(16 reference statements)

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“…However the major drawback is the significant higher risk of reinfection, bacteremia, and 3 Suggested algorithm for management of pseudoaneurysms due to intravenous drug abuse. U/S: ultrasonography; CT: computed tomography \ PRODUCTION [ Note that this algorithm was in the pdf file but not in the manuscript file even life-threatening hemorrhage if these patients use the prosthetic grafts as a route for injection [16,17]. Even if the extraanatomic bypass grafts avoided the contaminated field, either through the lateral thigh or the obturator route, the incidence of graft infection, thrombosis, and amputation remains high [16,17].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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Section: Discussionmentioning

confidence: 99%

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

et al. 2009

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“…240,281,[288][289][290][291] Postoperative ischemia and claudication occurred in 33% to 97% of patients, hemorrhage in 18% to 44%, and limb amputation in 5% to 33%. 240,281,[288][289][290][291] Ligation only of an MA involving the femoral artery is associated with a higher risk of postoperative claudication or amputation than with ligation of MA in the superficial femoral or tibial arteries. 163,281,285 Popliteal artery ligation carries a risk of amputation or severe chronic ischemia.…”

Section: Managementmentioning

confidence: 99%

“…199 Risk factors that predicted a poor outcome were persistent preoperative sepsis, aortoenteric fistula, and rupture, which were similar to those observed in the later study by Kan et al 198 Factors that were associated with favorable outcome were antibiotic therapy administered for at least 1 week preoperatively and the placement of image-guided drains to treat infection before EVT. 198,199,240 Razavi and Razavi 241 reported a literature review of 52 articles concerning 91 patients with aortic MA treated with open surgical repair or EVT. Among patients treated with open surgical treatment, the 30-day mortality rate was 11% to 43% compared with 5.6% after EVT.…”

Section: Clinical Statements and Guidelinesmentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

355

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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“…But the veins are not always available, and one needs a trained surgeon and yet there still lies a high chance for graft infection and bleeding. [13][14] No formalized policy has been reached as to the optimal management of infected pseudoaneurysm. 15 Based on literatures and our experience we have come up with a management protocol to help us treat our patients better.…”

Section: Discussionmentioning

confidence: 99%

Management of Femoral pseudoaneurysms in intravenous drugs users - A bubble trouble

Pradhan¹,

Shrestha²

2011

jgpeman

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Introduction: Femoral pseudoaneurysm in the intravenous drug users is a challenge to the treating surgeon. Surgical options range from ligation with excision to reconstruction using various kinds of grafts. However there is no generalized consensus on the optimal surgical treatment and the controversy persists. Methods: Medical charts of 10 consecutive patients presenting with infected femoral pseudoaneurysm of the lower limbs in emergency department,who underwent surgery in Bir Hospital from Jan 2008 to Dec 2010 were retrospectively analyzed. The patients were divided into two groups randomly based on the surgical management they had received. First was the reconstructive group and the second group underwent simple ligation of the femoral artery and excision of the pseudoaneurysm Results: All cases underwent emergency surgery. Extra anatomical Iliofemoral bypass was done in total of 7 cases, of which polytetrafluroethylenePTFE graft in 5 and Vein graft in 2 cases. Ligation of the femoral artery and excision of the pseudoaneurysm was done in 3 cases. In the reconstructive group 2 cases had to be operated twice for bleeding, 1 with PTFE graft and other with vein graft whereas 2 cases had late graft infection and was attributed to reinjection of drugs through the graft. All 4 cases underwent reoperation with ligation. In the second group with simple ligation and excision except for mild claudication, there were no other major complications. There was no mortality in both the groups. Conclusion: Intravenous drug users have high tendency to reuse femoral site for reinjection and thus arterial reconstruction maybe in jeopardy of recurrent infection and reoperation. Simple ligation with debridement and excision may prove to be a better option in cases of emergency surgery followed by delayed reconstruction if needed.

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Surgical Approach to Vascular Complications of Intravenous Drug Abuse

Abstract: 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.

Cited by 28 publications

References 18 publications

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

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

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Management of Femoral pseudoaneurysms in intravenous drugs users - A bubble trouble

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