BACKGROUND: Vascular complications resulting from i.v. drug abuse constitute a range of clinical problems from simple to serious. In addition, patients who present with these complications frequently have viral infections, which are a hazard to health care workers. PATIENTS AND METHODS: The present study is a retrospective review of 46 male drug addicts with 52 vascular complications (45 arterial, seven venous). Pseudoaneurysm of the femoral artery was the most common complication (n = 35). Fourteen of these patients underwent ligation of the common, superficial and deep femoral arteries above and below the pseudoaneurysm. Twenty-one underwent bipolar ligation of the common femoral artery after complete excision of the pseudoaneurysm. The decision to revascularize was based on the presence or absence of postligation Doppler signal. Arterial reconstruction was performed in five patients. All eight brachial artery pseudoaneurysms were ligated and excised, and deep vein thrombosis was managed with anticoagulation. RESULTS: There was no mortality but three patients had to undergo late amputations of the lower limb after successful salvage following the initial surgery. The median postoperative ankle-brachial indices, after bipolar and triple ligations were 0.51 and 0.46, respectively. Positive blood cultures were present in 30% of patients and tissue cultures were positive in 72%, the most common organism isolated was methicillin-sensitive Staphylococcus aureus. Six patients were positive for viral markers. The median hospital stay was 43 days. CONCLUSION: Ligation and excision of pseudoaneurysms without revascularization is safe for drug addicts provided it is based on the presence of a postligation Doppler signal.
BACKGROUND: Vascular complications resulting from i.v. drug abuse constitute a range of clinical problems from simple to serious. In addition, patients who present with these complications frequently have viral infections, which are a hazard to health care workers. PATIENTS AND METHODS: The present study is a retrospective review of 46 male drug addicts with 52 vascular complications (45 arterial, seven venous). Pseudoaneurysm of the femoral artery was the most common complication (n = 35). Fourteen of these patients underwent ligation of the common, superficial and deep femoral arteries above and below the pseudoaneurysm. Twenty-one underwent bipolar ligation of the common femoral artery after complete excision of the pseudoaneurysm. The decision to revascularize was based on the presence or absence of postligation Doppler signal. Arterial reconstruction was performed in five patients. All eight brachial artery pseudoaneurysms were ligated and excised, and deep vein thrombosis was managed with anticoagulation. RESULTS: There was no mortality but three patients had to undergo late amputations of the lower limb after successful salvage following the initial surgery. The median postoperative ankle-brachial indices, after bipolar and triple ligations were 0.51 and 0.46, respectively. Positive blood cultures were present in 30% of patients and tissue cultures were positive in 72%, the most common organism isolated was methicillin-sensitive Staphylococcus aureus. Six patients were positive for viral markers. The median hospital stay was 43 days. CONCLUSION: Ligation and excision of pseudoaneurysms without revascularization is safe for drug addicts provided it is based on the presence of a postligation Doppler signal.
Authors: Antoine Noel; Florent Le Ven; Martine Gilard; Luc Bressollette; Philippe Castellant; Ulric Vinsonneau; Nicolas Paleiron; Jacques Mansourati Journal: J Cardiol Cases Date: 2015-12-10