Wiener klinische Wochenschrift

, Volume 118, Supplement 2, pp 71–75

Infected femoral pseudoaneurysms from intravenous drug abuse in young adults

Case Report

Summary

Intravenous or parenteral drug abuse is the most common cause of infected femoral artery pseudoaneurysms (IFAP). This complication of intravenous drug abuse is not only limb threatening but can also be life threatening. The management of IFAP is difficult and controversial. Generally speaking, ligation and excision of the pseudoaneurysm without revascularization is accepted procedure in the majority of patients, with acceptable morbidity and low rate of limb loss. However, it is not an appropriate procedure for cases of acute interruption of the femoral artery flow, where a high probability of amputation is expected. We present four cases of young patients (average 19.5 years, range 17–24) with IFAP, where primary reconstruction was performed due to the absence of a Doppler signal over the pedal arteries after ligation of the common femoral artery. In two cases complications in the form of hemorrhage and repeated infection developed in the late postoperative period; in one case excision and ligation was performed, and in the last case reconstruction with a silver-impregnated dacron prosthesis. None of the patients required an amputation. Overall prognosis is uncertain because of the high incidence of postoperative drug injection despite aggressive drug rehabilitation.

Keywords

Femoral artery Pseudoaneurysm Drug abuse Intravenous Young adults 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Geelhoed GW, Joseph WL (1974) Surgical sequelae of drug abuse. Surg Gynecol Obstet 139: 749–755PubMedGoogle Scholar
  2. Anderson CB, Butcher HR, Ballinger WF (1974) Mycotic aneurysm of the drug addict. Arch Surg 109: 712–717PubMedGoogle Scholar
  3. Johnson JR, Ledgerwodd AM, Lucas CE (1983) Mycotic aneurysm: a new concept in therapy. Arch Surg 118: 577–582PubMedGoogle Scholar
  4. Albert CW, Ting MD, Stephen WK, Cheng MD (1997) Femoral pseudoaneurysms in drug addicts. World J Surg 21: 783–787CrossRefGoogle Scholar
  5. Tsao JW, Marder SR, Goldstone J, et al (2002) Presentation, diagnosis and management of arterial mycotic pseudoaneurysms in injection drug users. Ann Vasc Surg 16: 652–662PubMedCrossRefGoogle Scholar
  6. Willoughby CP, Evans E, Stoker TAM, Gabriel R (1984) Arterial hemorrhage in a drug addict. Br Med J 2: 307–308CrossRefGoogle Scholar
  7. Padberg F, Hobson R, Bing L, et al (1992) Femoral pseudoaneurysm from drugs of abuse: ligation or reconstruction? J Vasc Surg 15: 642–648PubMedCrossRefGoogle Scholar
  8. Reddy DJ, Smith RF, Elliot JP, et al (1986) Infected femoral artery false aneurysms in drug addicts: evolution of selective vascular reconstruction. J Vasc Surg 3: 718–724PubMedCrossRefGoogle Scholar
  9. Patel KR, Semel L, Clauss RH (1988) Routine revascularization with resection of infected femoral pseudoaneurysm from substance of abuse. J Vasc Surg 8: 321–328PubMedCrossRefGoogle Scholar
  10. Arora S, Weber MA, Fox CJ, et al (2001) Common femoral artery ligation and local debridement: a safe treatment for infected femoral artery pseudoaneurysms. J Vasc Surg 33: 990–993PubMedCrossRefGoogle Scholar
  11. Frezza EE, Mezghebe H (1998) Indications and complications of arterial cathether use in surgical or medical intensive care units: analysis of 4932 patients. Am Surgeon 64: 127–131PubMedGoogle Scholar
  12. Grotemeyer D, Graupe F, Mackrodt HG, Stock W (1998) Salmonella enteritidis infiziertes falsches Aneurysma der Arteria femoralis superficialis bei einem HIV-seropositiven Patienten. Chirurg 69: 204–207PubMedCrossRefGoogle Scholar
  13. Woodburn KR, Murie JA (1996) Vascular complications of injecting drug misuse. Br J Surg 83: 1929–1334Google Scholar
  14. Crane LR, Levine DP, Zervos MJ, Cummings G (1986) Bacteremia in narcotics addicts at the Detroit Medical Centre. I. Microbiology, epidemiology, risk factors, and empiric therapy. Rev Infect Dis 8: 364–373PubMedGoogle Scholar
  15. DeBakey ME, Simeone F (1946) Battle injuries of the arteries in World War II: an analysis of 2471 cases. Ann Surg 123: 534–579CrossRefPubMedGoogle Scholar
  16. Reddy DJ, Shepard AD, Evans JR, et al (1991) Management of infected aortoiliac aneurysms. Arch Surg 126: 873–879PubMedGoogle Scholar
  17. Kaiser MM, Kujath P, Müller G, Bruch HP (1997) Behandlungsstrategien inguinaler Spritzenabszesse und ihrer Komplikationen. Chirurg 68: 1029–1034PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  1. 1.Department of Abdominal SurgeryMaribor Teaching HospitalMariborSlovenia
  2. 2.Department of Vascular SurgeryMaribor Teaching HospitalMariborSlovenia

Personalised recommendations