Treatment of Arterial Lesions in Drug Addicts

Devecioglu, Muhamet; Settembre, Nicla; Samia, Zaki; Elfarra, Mazen; Malikov, Sergueï

doi:10.1016/j.avsg.2012.12.010

Cited by 13 publications

(19 citation statements)

References 14 publications

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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%

“…125 The most common microorganisms causing peripheral MA are S aureus, which are frequently MRSA. 125,163,[281][282][283][284][285] Less commonly, coagulase-negative staphylococci, gram-negative bacilli, Candida, and other microorganisms have been recovered, and in IVDUs, infection can be polymicrobial. 125 …”

Section: Frequencymentioning

confidence: 99%

“…It is estimated that peripheral MAs occur in ≈0.14% of those who inject drugs. 281,282 Maliphant and Scott 282 estimated that the average duration of continuous intravenous injection of drugs is 7.7 years until the user exhausts the accessible peripheral veins and begins to inject drugs intraarterially. 281,282 Femoral arteries are more readily accessible to IVDUs than are humeral or axillary arteries.…”

Section: Frequencymentioning

confidence: 99%

“…MAs involving the popliteal or external carotid artery are rare. 125,163,281 Pathogenesis, Risk Factors, and Microbiological Cause The anatomic location reflects the sites that are most readily accessible to IVDUs. It is estimated that peripheral MAs occur in ≈0.14% of those who inject drugs.…”

Section: Frequencymentioning

confidence: 99%

“…Ultrasonography or CTA may be considered for the diagnosis. 162,281,288 Ultrasonography is useful to distinguish cellulitis or abscess from MA. 163 To-and-fro filling of a pseudoaneurysm demonstrated by Doppler ultrasonography is suggestive of an MA in susceptible patients.…”

Section: Clinical Presentationmentioning

confidence: 99%

See 4 more Smart Citations

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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