Mycotic aneurysms in intravenous drug abuse: diagnosis and management.

Mycotic aneurysms are caused by microorganisms in the vessel wall. The most commonly reported cause of mycotic aneurysms today is intravenous drug abuse. The diagnosis should be entertained whenever a mass is encountered over a major vessel in an intravenous drug abuser. The clinical findings often include a tender, pulsatile mass overlying an artery. The single best diagnostic test is the arteriogram. The treatment is based on early exploration with debridement of all necrotic and infected tissue, effective drainage, and appropriate antibiotic coverage.Restoration of vascular continuity is desirable when possible, and necessary when the viability of the extremity requires it. When reconstitution of the vessel is contemplated, the following principles are advocated (1) resection of all nonviable arterial wall, (2) use of monofilament synthetic suture, (3) achievement of a tension-free anastomosis with or without the use of autogenous grafts, (4) effective local drainage, and (5) appropriate antibiotic coverage.