Graft Infection after Prosthetic Bypass Surgery for Infectious Femoral Artery Pseudoaneurysm in Intravenous Drug Users: Manifestation, Management, and Prognosis

Li, Ké; Beckerman, William E.; X, Luo; Peng, Han; Chen, Ke Qin; He, Chao

doi:10.1016/j.avsg.2020.06.058

Cited by 4 publications

(2 citation statements)

References 16 publications

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“…Thirty-day mortality in patients with aortic endograft infections can reach up to 17%, whereas in-hospital mortality rates of aortic prosthetic grafts are reported to be up to 20% [ 16 ]. IV drug abusers are particularly at risk of such infections [ 3 ]. First, repeated use of IV injections under nonsterile conditions can introduce and disseminate infection into the bloodstream.…”

Section: Discussionmentioning

confidence: 99%

“…Known revascularization strategies include endovascular intervention and open surgical repair via endarterectomy or bypass grafting. However, placement of a prosthetic graft in the abdomen, pelvis, or groin carries the risk of catastrophic graft infection, particularly in the case of intravenous (IV) drug abusers, with a significant increase in morbidity and mortality [ 2 , 3 ]. Likewise, the introduction of bacteria into the bloodstream through inadvertent arterial cannulation or repeated venipuncture under nonsterile settings in IV drug abuse can also infect the endovascular material [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Leriche Syndrome with Digital Gangrene: Is Aortic Bypass Grafting Safe in Intravenous Drug Abusers? A Case Report and Literature Review

Ali¹,

Ather²,

Malik³

2022

Vasc Specialist Int

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A 47-year-old male with Leriche syndrome presented with digital gangrene due to TASC II type-D occlusion of the distal aorta and common iliac arteries. Open revascularization was performed using a Dacron aorto-biiliac bypass graft; however, the postoperative course revealed a nondisclosed history of intravenous opioid abuse as he went into withdrawal psychosis. Our report highlights ways to mitigate infection risk associated with prosthetic aortic grafts in suspected or confirmed intravenous drug abusers. The literature review suggests alternative strategies like aortoiliac endarterectomy, total endovascular approach using non-covered stents, or a hybrid approach. The primary use of autologous venous grafts should be considered as a last resort so that the veins are retained for future use in case of graft infection. Patient factors like comorbidities, fitness to undergo surgery, anatomical extent of occlusion, and availability of facilities/expertise can further guide the management plan owing to a lack of evidence-based guidelines.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Leriche Syndrome with Digital Gangrene: Is Aortic Bypass Grafting Safe in Intravenous Drug Abusers? A Case Report and Literature Review

Ali¹,

Ather²,

Malik³

2022

Vasc Specialist Int

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An out of the box treatment for an infected pseudoaneurysm: Deep to superficial femoral artery transposition

Rabinovich¹,

Klemperer²,

Levi³

et al. 2023

Journal of Vascular Surgery Cases, Innovations and Techniques

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Comparison between covered-stents grafting and ligation in the treatment of infected femoral pseudoaneurysm due to intravenous drug abuse

Zeng,

Yuan,

2024

Vascular

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Objectives The study compared the outcomes between covered-stents grafting (CSG) and ligation of femoral artery (LFA) in the treatment of infected femoral pseudoaneurysm (IFP) caused by intravenous drug injection. Methods From 1st January 2016 to 30th November 2021, the clinical data of patients with IFP caused by intravenous drug injection who underwent CSG ( n = 31, 55.4%) and LFA ( n = 25, 45.4%) are retrospectively analyzed. We compared the baseline characteristics and clinical outcomes of the two groups, including early and late mortality and morbidity. Results A total of 56 patients were enrolled in the study, comprising 50 (89.3%) men and 6 (10.7%) women, with a mean age of 34.3 years. There was no significant difference observed between the two groups in terms of 30-day mortality (3.2% vs 0%, p = .365) and length of stay (9 [7, 12] vs 11 [8.5, 12.5] days, p = .236). However, group CSG exhibited a lower rate of intermittent claudication (0% vs 32%, p = .001), less blood loss (67.1 ± 22.5 mL vs 177.0 ± 59.8 mL, p < .001), and shorter surgery duration (57.5 ± 9.9 min vs 84.4 ± 22.8 min, p < .001) compared to group LFA. The LFA group were divided into subgroups according to the ligation site. The amputation rate of superficial femoral artery ligation group (0 vs 27.3%, p = .014) was significantly lower than common femoral artery ligation. Conclusions Covered-stents grafting may be a preferable treatment to LFA for IFP due to intravenous drug abuse, particularly when the entry tear is located in the common femoral artery.

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Graft Infection after Prosthetic Bypass Surgery for Infectious Femoral Artery Pseudoaneurysm in Intravenous Drug Users: Manifestation, Management, and Prognosis

Cited by 4 publications

References 16 publications

Leriche Syndrome with Digital Gangrene: Is Aortic Bypass Grafting Safe in Intravenous Drug Abusers? A Case Report and Literature Review

Leriche Syndrome with Digital Gangrene: Is Aortic Bypass Grafting Safe in Intravenous Drug Abusers? A Case Report and Literature Review

An out of the box treatment for an infected pseudoaneurysm: Deep to superficial femoral artery transposition

Comparison between covered-stents grafting and ligation in the treatment of infected femoral pseudoaneurysm due to intravenous drug abuse

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