Changes in the demographics of intravenous drug users with mycotic common femoral artery pseudoaneurysm as a consequence of self-injection does not influence outcome following emergency ligation

Abstract

Objectives The reported annual incidence of mycotic pseudoaneurysm of the common femoral artery in intravenous drug users has been estimated at 0.03%. Over the past 5 years in Scotland, the proportion of people receiving specialist attention for heroin use over the age of 40 years has increased from 15 to 22%. Although routinely managed with arterial ligation (without reconstruction), some series have reported rates of major limb amputation of up to 10%. We sought to define whether this management strategy was still acceptable in an older population. Methods Retrospective review of patients presenting to a tertiary vascular service with mycotic pseudoaneurysm of the common femoral artery due to arterial injection by intravenous drug users between October 2010 and March 2016. Variables of interest included patient demographics and requirement for major amputation. Results There were 55 patients identified. The annual incidence of mycotic pseudoaneurysm of the common femoral artery in intravenous drug users was 2.1%. It was more common in men (3:1) and the mean age at presentation was 41 years (standard deviation ± 8 years). Three patients underwent major limb amputation during the index admission for severe limb ischaemia (two transfemoral amputations; one hip-disarticulation). Following discharge two patients were readmitted (134 and 200 days, respectively, following primary ligation) for major limb amputation due to of critical limb ischaemia. Conclusions Despite the increasing age of intravenous drug users presenting with mycotic pseudoaneurysm of the common femoral artery primary ligation of pseudoaneurysm would seem to remain an appropriate therapeutic intervention.

Outcomes of Ligation without Revascularization in Pseudoaneurysms of Peripheral Arteries in Intravenous Drug Users

“… 12 , 13 Studies where ligation was done with intraoperative evidence of collateral (by adequate doppler signal in distal pedal artery, adequate capillary refill time and saturation on pulse oximetry) during intraoperative test occlusion, limb ischemia was as low as 0 to 8%. 9 , 14 , 15 There are several advantages of ligation alone. The conduit issue is avoided, the operative time in septicemia is reduced, and the complications are minimal as has been seen in our study.…”

<p>Mycotic pseudoaneurysm in intravenous drug users: current insights</p>

“…9 The annual incidence of mycotic pseudoaneurysm of the common femoral artery ranges from 0.03% 9 to 1%. 10,11 This figure is perhaps surprising, given that of 3,733 IVDU surveyed in England, Wales and Northern Ireland, 35% reported infection at injection sites within the previous 12 months. 12 Features associated with infection include frequency of injection, duration of time injecting and those who had recently used a needle exchange program.…”

Surgical Treatment of Ruptured Infectious Femoral Pseudoaneurysms Caused By Intravenous Drug Abuse: A Nonemergent (Postponed) Operation Pattern May Be a Possible Alternative

“…Infectious femoral artery pseudoaneurysm (I-FAP) is a common complication caused by repeated intravenous drug injection [1] . In addition to painful and pulsatile lumps in the femoral region, drug abusers with pseudoaneurysms often present with abscesses, cellulitis and endocarditis, which together contribute to disease progression and eventually lead to aneurysm rupture and active bleeding.…”