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

Qiu, Jian; Zhou, Wei; Tang, Xinhua; Yuan, Qing; Zhu, Xiaoxin; Yang, Yujin; Xiong, Jixin

doi:10.1016/j.avsg.2016.03.030

Cited by 23 publications

(22 citation statements)

References 14 publications

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“…In our case, we believe that the infectious process associated with the endovascular intervention were responsible for the FAP. The treatment is controversial, but open surgical repair represents a very high risk option, and arterial ligation tends to be the most indicated procedure, which was the case with our patient 38 , 39…”

Section: Discussionmentioning

confidence: 59%

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Mycotic aneurysm with aortoduodenal fistula

et al. 2017

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Firstly described in the 19th century by Sir William Osler, the mycotic aneurysm (MA) is a rare entity characterized by an abnormal arterial dilation, which is potentially fatal, and is associated with the infection of the vascular wall. Elderly patients are mostly involved, especially when risk factors like chronic diseases, immunosuppression, neoplasia, and arterial manipulation are associated. The authors report the case of a young male patient diagnosed with an aortic aneurysm of infectious origin in the presence of repeated negative blood cultures. The diagnostic hypothesis was raised when the patient was hospitalized for an inguinal hernia surgery. The diagnosis was confirmed based on imaging findings consistent with mycotic aneurism. The patient was treated with an endovascular prosthesis associated with a long-lasting antibiotic therapy. Five months later, the patient attended the emergency unit presenting an upper digestive hemorrhage and shock, from which he died. The autopsy revealed a huge aneurysm of the abdominal aorta with an aortoduodenal fistula. The histological examination of the arterial wall revealed a marked inflammatory process, extensive destruction of the arterial wall, and the presence of Gram-positive bacteria. This case highlights the atypical presentation of a MA associated with an aortoduodenal fistula. Besides the early age of the patient, no primary arterial disease could be found, and no source of infection was detected.

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Section: Discussionmentioning

confidence: 59%

“…FAPs are mostly described in drug addicted or immunosuppressed patients. The main etiologies involve trauma, vessel wall infection, surgeries, and endovascular procedures 37 - 39. Ultrasound is the most common method to diagnose FAPs 37.…”

Section: Discussionmentioning

confidence: 99%

Mycotic aneurysm with aortoduodenal fistula

et al. 2017

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“…Qui et al found that most patients with a drug use history of over 5 years had no claudication symptoms at all [9]. It is believed that patients with longstanding intravenous drug abuse develop an adequate collateral blood supply and as they are frequently young are often free from underlying atherosclerotic disease [10] thus less likely to require a subsequent amputation following ligation of the common femoral artery.…”

Section: Discussionmentioning

confidence: 99%

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

Rammell

Kansal

Bhattacharya

2017

International Journal of Surgery Case Reports

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HighlightsInfected femoral pseudoaneurysms are a common presentation in intravenous drug users with little consensus as to their optimum management.Excision and ligation of the femoral artery without revascularisation is the most common operative intervention.With the identification and optimisation of suitable patients, revascularisation can be performed in the emergency setting.Current endovascular approaches appear to be used only as a bridge to a future definitive revascularisation procedure.Ligation of the common femoral artery without revascularisation is both safe and effective as most patients will avoid critical ischaemia.

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“…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] .…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Ahmad

Poh

Imray

2017

International Journal of Surgery Case Reports

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HighlightsInitial hybrid approach to achieve haemorrhagic and sepsis control is a viable option as a bridge to delayed definitive arterial reconstruction .Endovascular stent-grafting provides an alternative treatment strategy to arterial ligation in cases of ruptured mycotic pseudoaneurysms.Anticipation of stent-graft infection can allow time to plan for delayed arterial reconstruction.Subsequent stent-graft removal and reconstruction can preclude complications of arterial ligation, including claudication and limb-loss.

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

Cited by 23 publications

References 14 publications

Mycotic aneurysm with aortoduodenal fistula

Mycotic aneurysm with aortoduodenal fistula

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

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

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