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DDin NU, Berlas FT, Rehman KU, Ali G, Salahuddin F, Mumtaz A. Outcomes of Femoral Artery Pseudoaneurysm in Intravenous Drug Abusers Managed at a Tertiary Care Center. Cureus 2021; 13:e13350. [PMID: 33643755 PMCID: PMC7885738 DOI: 10.7759/cureus.13350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives The aim of this study was to assess the effects of ligation and excision of femoral artery pseudoaneurysm without revascularization in intravenous drug abusers presenting in the tertiary care center. Methods This was a retrospective study conducted at Shaheed Mohtarma Benazir Bhutto Institute, Karachi, Pakistan, and included 119 patients admitted for vascular injuries of the groin between June 2016 and June 2020. Data collected from the hospital's medical records included all intravenous drug addicts presented with mass near or at groin area only, while other pseudoaneurysm locations secondary to vascular trauma, arteriovenous fistula, and hemodialysis were excluded. SPSS Version 20.0 (IBM Corp., Armonk, NY, USA) was used for data analysis. Results This study included 119 patients, all of whom presented and admitted to the Accident and Emergency Department, with a mean age of about 32 years ± 11.34 years and a mean duration of addiction of 2.47 years ± 1.37 years. Males constituted 83.2% of the patients, while females constituted 16.8%. The left femoral artery was affected more commonly than the right femoral artery, with an average of 75.6% and 24.4%, respectively. The most common presentation was bleeding from ruptured pseudoaneurysm (76.5%) and oozing with pulsatile mass (17.6%), while infected pulsatile swelling and misdiagnosis were uncommon. After surgical intervention, limb salvage was 95.8%, whereas mortality and amputation rate were 2.5 % and 1.7%, respectively. Conclusion The optimal management of femoral artery pseudoaneurysm in intravenous drug addicts is ligation and excision of the pseudoaneurysm without revascularization.
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Affiliation(s)
- Najam U DDin
- Department of Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
| | - Fahad Tariq Berlas
- Department of Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
| | - Khalil Ur Rehman
- Department of Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
| | - Ghulam Ali
- Department of Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
| | - Farhina Salahuddin
- Department of Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
| | - Asma Mumtaz
- Department of Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
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Rehman KU, Berlas MF, Din NU, Ali G, Salahuddin F, Mumtaz A. Management of Brachial Artery Pseudoaneurysms in Intravenous Drug Abusers. Cureus 2020; 12:e12315. [PMID: 33520513 PMCID: PMC7837668 DOI: 10.7759/cureus.12315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2020] [Indexed: 11/16/2022] Open
Abstract
Objective To determine the outcomes of the ligation and excision of brachial artery pseudoaneurysm in IV drug abusers without revascularization. Methodology This retrospective observational study was conducted at the vascular surgery department Shaheed Muhtarma Benazir Bhutto trauma center Karachi from January 2019 to June 2020. All the patients with a history of intravenous drug abuse presented with pulsatile mass at or near cubital fossa, diagnosed as pseudoaneurysm, age ranging from 18-70 years, and of either gender were included in the study. Patients with pseudo-aneurysm secondary to trauma, hemodialysis, arteriovenous fistula, location other than cubital fossa, and whom primary revascularization was performed were excluded. The recorded data entered and analyzed using SPSS 20.0 (IBM Corp., Armonk, NY). Results A total of 20 intravenous drug addicts were included in the study. The mean age was of 31.10 ± 7.80 years, and the mean duration of addiction was 2.24 ± 1.16 years. The right arm is affected in almost two-thirds of patients. The most common presentation in the emergency department was ruptured pseudo-aneurysm with bleeding (65%), followed by oozing with pulsatile mass (30%), and infected pulsatile mass (5%). The outcome was Limb salvage (100%), and none of the patients had developed threatened ischemia of the arm or required amputation. Conclusion The ligation and excision of the pseudo-aneurysm, without revascularization, is a safe and effective treatment option for the management of pseudoaneurysm of the brachial artery secondary to intravenous drug addiction.
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Affiliation(s)
- Khalil Ur Rehman
- Department of Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
| | - Muhammad Fahad Berlas
- Department of Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
| | - Najam U Din
- Department of Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
| | - Ghulam Ali
- Department of Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
| | - Farhina Salahuddin
- Department of Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
| | - Asma Mumtaz
- Department of Vascular Surgery, Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, PAK
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Bianchini Massoni C, Mariani E, De Troia A, Perini P, Nabulsi B, D'Ospina RM, Freyrie A. Outcomes of Surgical and Endovascular Treatment for Arterial Lesions in Intravenous Drug Abusers. Ann Vasc Surg 2020; 69:133-140. [PMID: 32561239 DOI: 10.1016/j.avsg.2020.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND The objective of this study is to report an 18-year single-center experience in the surgical and endovascular treatment of arterial complications due to self-injection in drug abuser patients. METHODS This retrospective single-center study was conducted analyzing a prospectively collected database including all endovascular or surgical procedures performed from January 2007 to December 2019 for any arterial complication due to self-injection in drug abuser patient. Collected data were patient demographic and comorbidity, site and type of arterial lesion (pseudoaneurysm [PA], arteriovenous fistula [AVF]), signs of systemic or local infection, and procedural data (endovascular/surgical treatment). End points were rate of postoperative complications, reintervention rate, limb salvage, and patients' early and long-term survival. RESULTS In 11 patients (median age 36 years, range 27-47; male 73%), 13 arterial lesions were treated: 10 (77%) PA, 2 (15%) PA associated with AVF, and 1 (8%) isolated AVF. Arterial lesion involved common femoral artery in 5 (38%), superficial femoral artery in 4 (31%), profunda femoral artery in 1 (8%), brachial artery in 2 (15%), and subclavian artery in 1 (8%). Signs of infections were present in 9 of the 13 cases (69%). The treatment was surgical in 11 (85%) cases: 7 interposition graft (6 great saphenous vein, 1 arterial cryopreserved homograft), 2 direct reconstruction, 1 patch plasty with pericardium bovine patch, and 1 arterial ligation. Endovascular treatment was performed in 2 cases: 1 noninfected PA of the superficial femoral artery, and 1 55-mm PA of the postvertebral segment of the right subclavian artery with clinical sign of hemodynamic instability. At 1 month, postoperative complication rate was 8% (one lower limb claudication after superficial femoral artery ligation). Reintervention rate was 8% (interposition graft rupture for repeated self-injections). Limb salvage and patient survival were both 100%. Median follow-up was 5 years (range 1 month to 11.3 years); surgical group: median 8.2 years (range 2 months to 11.3 years); endovascular group: median 3.5 months (range 1-6). During follow-up, neither complications nor reinterventions occurred, and limb salvage was 100% for both groups. At 2, 4, and 6 years, overall estimated patient survival was 91%, 81%, and 81%, respectively, with no procedure-related death. CONCLUSIONS After surgical or endovascular management of arterial lesions due to self-injection in drug abuser patients, complications occur mainly in the postoperative period. During follow-up, the surgical procedures have low rate of complications, reinterventions, and procedure-related mortality, whereas for the endovascular treatment the mid-term outcomes remain unknown.
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Affiliation(s)
| | - Erica Mariani
- Department of Medicine and Surgery, Vascular Surgery, University of Parma, Parma, Italy
| | - Alessandro De Troia
- Department of Medicine and Surgery, Vascular Surgery, University of Parma, Parma, Italy
| | - Paolo Perini
- Department of Medicine and Surgery, Vascular Surgery, University of Parma, Parma, Italy
| | - Bilal Nabulsi
- Department of Medicine and Surgery, Vascular Surgery, University of Parma, Parma, Italy
| | - Rita Maria D'Ospina
- Department of Medicine and Surgery, Vascular Surgery, University of Parma, Parma, Italy
| | - Antonio Freyrie
- Department of Medicine and Surgery, Vascular Surgery, University of Parma, Parma, Italy
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Ilic A, Stevanovic K, Pejkic S, Markovic M, Dimic A, Sladojevic M, Davidovic L. Vascular Injuries in Intravenous Drug Addicts-A Single-Center Experience. Ann Vasc Surg 2020; 67:185-191. [PMID: 32335251 DOI: 10.1016/j.avsg.2020.02.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Infected false aneurysms (IFA) caused by intravenous drug abuse are uncommon but challenging lesions. The best approach for the surgical management of this condition is still unknown. The aim is to present a single-center 14-year experience in the IFA treatment in intravenous drug abusers, thus providing additional data regarding the treatment options and outcome in these patients. METHODS A retrospective analysis of 32 consecutive patients with vascular injuries secondary to intravenous drug abuse, during the period from January 2004 to April 2018, was performed. Data of interest were extracted from patients' medical history records, anesthesia charts, and database implemented in daily practice, or were obtained by personal contact. The diagnosis was set based on history, physical examination and/or color Doppler sonography, multidetector computed tomographic angiography, and digital subtraction angiography. The outcome included graft patency, limb amputation, and mortality. RESULTS During study period, 32 heroin abusers, predominantly males (81%), were surgically treated due to vascular injuries, with mean age of 35.2 years. The vast majority of patients have had an injury of the lower extremity blood vessels (84.3%) and the common femoral artery was the most common site of injury (59.4%). Three-quarters of patients underwent resection of the false aneurysm and ligation of the artery without reconstruction of the blood vessel. In 7 cases (21.9%), arterial reconstruction was performed with overall failure rate of 42.86%. The overall mortality rate was 6.25% and the rate of extremity salvage was 96.7%. CONCLUSIONS The best treatment option is yet to be found, but based on the results of the present study, ligation of affected artery without revascularization seems to be an efficient, safe, and optimal treatment method, with minor risk of the extremity loss.
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MESH Headings
- Adult
- Amputation, Surgical
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/microbiology
- Aneurysm, False/mortality
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/mortality
- Aneurysm, Infected/surgery
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation/adverse effects
- Blood Vessel Prosthesis Implantation/instrumentation
- Blood Vessel Prosthesis Implantation/mortality
- Drug Users
- Female
- Heroin Dependence/complications
- Heroin Dependence/diagnosis
- Heroin Dependence/mortality
- Humans
- Ligation
- Limb Salvage
- Male
- Middle Aged
- Retrospective Studies
- Risk Factors
- Substance Abuse, Intravenous/complications
- Substance Abuse, Intravenous/diagnosis
- Substance Abuse, Intravenous/mortality
- Time Factors
- Treatment Outcome
- Vascular Patency
- Vascular System Injuries/diagnostic imaging
- Vascular System Injuries/microbiology
- Vascular System Injuries/mortality
- Vascular System Injuries/surgery
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Affiliation(s)
- Anica Ilic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Ksenija Stevanovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia.
| | - Sinisa Pejkic
- Department of Vascular Surgery, Mater Dei Hospital, Msida, Malta
| | - Miroslav Markovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - Andreja Dimic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - Milos Sladojevic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia
| | - Lazar Davidovic
- Clinic for Vascular and Endovascular Surgery, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Serbia
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Becker D, Béguin M, Weiss S, Wyss TR, Schmidli J, Makaloski V. In situ Reconstruction of Infected Groin Pseudoaneurysms in Drug Abusers With Biological Grafts. Eur J Vasc Endovasc Surg 2019; 58:592-598. [DOI: 10.1016/j.ejvs.2019.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/27/2019] [Accepted: 04/28/2019] [Indexed: 02/07/2023]
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Association between Drug Use and In-hospital Outcomes after Infrainguinal Bypass for Peripheral Arterial Occlusive Disease. Ann Vasc Surg 2019; 58:122-133.e4. [DOI: 10.1016/j.avsg.2018.12.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/01/2018] [Accepted: 12/03/2018] [Indexed: 11/22/2022]
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Xu J, Zheng Z, Yang Y, Zhang W, Zhao H, E B, Zheng M. Clinical evaluation of covered stents in the treatment of superficial femoral artery pseudoaneurysm in drug abusers. Mol Med Rep 2018; 17:4460-4466. [PMID: 29344667 PMCID: PMC5802221 DOI: 10.3892/mmr.2018.8431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 12/04/2017] [Indexed: 01/04/2023] Open
Abstract
The present study aimed to investigate the technical feasibility and initial clinical outcomes of a covered stent for the endovascular treatment of superficial femoral artery (SFA) pseudoaneurysm in drug abusers. A total of 29 drug abuse patients with SFA pseudoaneurysm, as confirmed by color Doppler sonography, were enrolled to the present study between January 2012 and May 2014. All patients were treated percutaneously by implantation of a covered stent. Physical examination and lower extremity computed tomography angiography were performed at 1 and 9 months postoperation. Furthermore, the ankle-brachial index (ABI) of all patients was measured. The results indicated that placement of the covered stent was technically successful in all 29 patients. All of the ruptured pseudoaneurysms were successfully sealed with no cases of intraprocedural mortality. In addition, all patients' conditions improved rapidly; active hemorrhage subsidence and vascular bruit disappearance were immediately detected following implantation of the covered stent. During the follow-up period, pain was markedly alleviated and pulsatile mass was decreased as time increased. No complaints or complications were documented. A total of 9 months postoperation, pain and pulsatile mass were not detected. The patency rate of the stent was 100%, and no migration, occlusion or infection was detected. In addition, the ABI was significantly improved, from 0.52±0.09 to 0.97±0.37 (P<0.01). In conclusion, the placement of a covered stent may be considered a promising approach to provide an effective, safe and minimally invasive option for the treatment of SFA pseudoaneurysm in drug abusers.
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Affiliation(s)
- Jian Xu
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Zhao Zheng
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Yong Yang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Wei Zhang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Hongliang Zhao
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Bei E
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Minwen Zheng
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
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Wilson WR, Bower TC, Creager MA, Amin-Hanjani S, O’Gara PT, Lockhart PB, Darouiche RO, Ramlawi B, Derdeyn CP, Bolger AF, Levison ME, Taubert KA, Baltimore RS, Baddour LM. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e412-e460. [DOI: 10.1161/cir.0000000000000457] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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9
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The Treatment of Infected Femoral Artery Pseudoaneurysms Secondary to Drug Abuse: 11 Years of Experience at a Single Institution. Ann Vasc Surg 2016; 36:35-43. [DOI: 10.1016/j.avsg.2016.03.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/12/2016] [Accepted: 03/23/2016] [Indexed: 11/22/2022]
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Boieru R, Georg Y, Ramlugun D, Martinot M, Camin A, Matysiak L, Kretz B. Endovascular Treatment of Infected Brachial Pseudoaneurysm in an Intravenous Drug Abuser: A Case Report. Ann Vasc Surg 2015; 29:1449.e13-6. [PMID: 26142880 DOI: 10.1016/j.avsg.2015.04.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/25/2015] [Accepted: 04/06/2015] [Indexed: 11/19/2022]
Abstract
We report the case of a 36-year-old male, admitted in the emergency room with a nonruptured brachial pseudoaneurysm after buprenorphine injection, with no signs of distal acute ischemia. After endovascular treatment with a nitinol covered stent associated with adapted antibiotherapy and 35 days of hospitalizations, the patient was discharged with good short results but stent need to be removed at 6 months for thrombosis and partial exposure through the wound.
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Affiliation(s)
- Raluca Boieru
- Service de Chirurgie Vasculaire, Hôpital Pasteur, Colmar, France
| | - Yannick Georg
- Service de Chirurgie Vasculaire et de Transplantation Rénale, Nouvel Hôpital Civil, Strasbourg, France
| | | | - Martin Martinot
- Service des Maladies Infectieuses, Hôpital Pasteur, Colmar, France
| | - Amelie Camin
- Service de Chirurgie Vasculaire, Hôpital Pasteur, Colmar, France
| | - Lucien Matysiak
- Service de Chirurgie Vasculaire, Hôpital Pasteur, Colmar, France
| | - Benjamin Kretz
- Service de Chirurgie Vasculaire, Hôpital Pasteur, Colmar, France.
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