Infected femoral pseudoaneurysms in intravenous drug abusers: a decade of experience from a Singapore tertiary centre

INTRODUCTION@#A pseudoaneurysm (or false aneurysm) is a haematoma that communicates with an artery through a disruption in the arterial wall. The femoral artery is the most common injection site among drug users, and infected femoral pseudoaneurysms are the most common vascular complications.@*METHODS@#A retrospective review of medical records of intravenous drug abusers (IVDAs) who presented with infected femoral pseudoaneurysms from January 2006 to December 2016 was carried out. Patients who had pseudoaneurysms due to other aetiologies or trauma were excluded.@*RESULTS@#A total of 27 patients with infected femoral pseudoaneurysms were identified. The majority were male (92.6%) and of Malay ethnicity (55.6%). Median age was 50 (range 31-62) years. Commonly abused drugs were buprenorphine (or Subutex; 59.3%) and midazolam (or Dormicum; 51.9%). Groin pain and swelling (100.0%), fever (66.7%) and presence of a pulsatile mass (51.9%) were the most common presenting symptoms. Diagnosis was confirmed via computed tomography angiography in all patients. 25 patients underwent upfront arterial ligation with debridement, among whom three patients required concurrent surgical revascularisation. Only two patients underwent ultrasonography-guided thrombin injection - one eventually required surgery and the other was lost to follow-up. Postoperative complications included wound infection (42.3%), bleeding (11.5%) and necrotising fasciitis eventually resulting in limb loss (3.8%). There were no associated mortalities.@*CONCLUSION@#Infected pseudoaneurysms in IVDAs pose a unique challenge to vascular surgeons. We found that simple ligation and debridement was a safe and effective option for such patients.

Endovascular treatment for ruptured femoral artery pseudoaneurysm associated with bleeding caused by injection of addictive drug / 介入放射学杂志

Objective To investigate the feasibility,safety and effectiveness of endovascular angioplasty with covered stent and embolization with spring coil in treating ruptured femoral artery pseudoaneurysm (FAP) associated with bleeding caused by injection of addictive drug.Methods The clinical data of 32 patients with ruptured FAP complicated by bleeding caused by injection of addictive drug,who were admitted to authors' hospital during the period from July 2012 to December 2015,were retrospectively analyzed.The average age of the patients was 36.5 years old,among them 25 patients were male (78.1％).Results Successful hemostasis was achieved in all 32 patients.The technical success rate of endovascular therapy was 100％,and no death occurred during perioperative period.Endovascular repair with covered stent was carried out in 25 patients (78.1％),embolization of femoral profound artery with spring coil in 9 patients (9.4％),and covered stent implantation together with embolization of femoral profound artery in 4 patients (12.5％).The patients were followed up for a mean of (17.5±11.6) months,with a follow-up rate being 93.8％ (30/32).The 3-year cumulative stent patency rate was 90.9％,and the 3-year overall survival rate was 91.3％.Conclusion For the treatment of ruptured FAP complicated by bleeding caused by injection of addictive drug,endovascular treatment is safe and effective with satisfactory mid-term clinical effect.This technique helps win the valuable time for critically ill patients to receive two-stage surgical debridement and vascular repair,as two-stage thorough debridement is an important means to control infection.

Iatrogenic Pseudoaneurysm of Iliac-femoral Artery; the Efficacy of Ultrasound-guided Thrombin Injection Therapy

PURPOSE: As a consequence of the widespread application of coronary and peripheral interventional procedures, the incidence of a femoral pseudoaneurysm is increasing. Along with the traditional surgical approach, ultrasound-guided compression or thrombin injection therapy has recently been developed and is widely used to reduce surgical morbidity. The efficacy of these therapies was compared to define the guidelines for treating an iatrogenic femoral pseudoaneurysm in Korean patients. METHODS: Ultrasound-guided therapies were performed prospectively since October 2000. The results of the surgical repair from July 1996 were reviewed retrospectively. A total 22 patients with an iliofemoral pseudoaneurysm were enrolled in this study. RESULTS: Surgical repair was performed in 12 cases, ultrasound-guided compression therapy in 1 case, and ultrasound-guided thrombin injection in 9 cases. A primary closure of the puncture site (11 cases) and an iliac artery interposition graft (1 case) were performed. Postoperative complications developed in 4 cases; wound hematoma, wound infection and ureter injury. Compression therapy was successfully performed in 1 case. A thrombin injection was performed in 9 cases. Immediate thrombotic obliteration of the pseudoaneurysm occurred in all cases. Partial recannalization was detected during follow-up duplex sonography in 1 case, who was successfully treated by an additional thrombin injection. There were no complications associated with the thrombin injection and no recurrence had occurred during the 4 weeks follow-up. CONCLUSION: Thrombin injection therapy is highly efficient, safe, and comfortable. Ultrasound-guided thrombin injection could be the initial treatment of choice for treating iatrogenic femoral pseudoaneurysm.

Management of femoral pseudoaneurysm due to the drug injection

In recent years, the vascular complications in drug addict have increased. Rupture of femoral pseudoaneurysms with infection, bleeding are presented in the majority of patients. In local medical centers, the general surgeons can operated on it if they know the principle of treatment. During 5 years, form 1.1997 to 11.2001, a total of 82 drug abusers presenting with infected femoral pseudo aneurysms were 74 men (90.24%) and 8 women (9.76%) with mean ages 30.3 years (from 16 to 55 years). Compressive bandage is used as the first treatment of all who came to hospital with rupture of femoral pseudoaneurysms. Arterial ligation is known as the radical treatment, arterial reconstruction without results because of infection (one patient).

Surgical Treatment of the Femoral Pseudoaneurysm Resulted from Drugs Injection / 中国医师杂志

Objective To evaluate surgical mangement of femoral pseudoaneurysm caused by injection of addictive drugs. Methods The clinical data of 13 cases with femoral pseudoaneurysm resulted from drugs injection were retrospectively analyzed. All cases underwent operation treatment. 1 case received aneurysmectomy and lacerative repair, and 13 cases received aneurysmctomy and vascular grafting. The grafts included autogenous saphenous vein, artificial blood vessel and so on. Results The postoperative color ultrasound Doppler detection showed that all of the vascular grafts were patent, and the limbs of all the 13 patients were salvaged. Conclusion Complete debridement,vascular reconstruction and proper treatment of complications were the key factors of treating successfully the femoral pseudoaneurysm resulted from drugs injection.