Infected False Aneurysms of the Limbs Secondary to Chronic Intravenous Drug Abuse: Analysis of Perioperative Considerations and Operative Outcomes

Georgiadis, George S.; Bessias, Nikolaos; Pavlidis, P.; Pomoni, Maria; Batakis, Nikolaos; Lazarides, Miltos K.

doi:10.1007/s00595-006-3495-z

Cited by 14 publications

(7 citation statements)

References 33 publications

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“…Penetrating trauma in the form of stab, industrial injury, firearm discharge, and sometimes manipulation during orthopedic surgery are the other frequent causes [1,4]. The femoral artery is seen to be the commonest artery affected followed by brachial artery as studied by Georgiadis and in our study as well [6].…”

Section: Discussionsupporting

confidence: 67%

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Peripheral Arterial Pseudoaneurysms—a 10-Year Clinical Study

2013

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Peripheral arterial pseudoaneurysms are quite common in Northern India (Punjab Province) and thus a common presenting complaint of varied etiology. The objective of this study was to evaluate the clinical outcome of patients presenting with peripheral arterial pseudoaneurysms of varied etiology. Retrospective analysis of medical records of patients with diagnosis of peripheral arterial pseudoaneurysm from 1 May 2001 to 30 October 2009 was done. In the prospective period from 1 November 2009 to 30 April 2011, the patients were personally examined by the authors and followed up till discharge from the hospital and subsequently at 2 weeks, 1 month, 3 months, and 6 months postdischarge from the hospital. We studied 50 patients (13 in the prospective group and 37 in the retrospective study group). Intravenous drug abuse (26 cases) followed by trauma (nine cases) was the commonest etiology. Femoral artery was the commonest artery involved (37 cases). A pulsatile mass with localized tenderness was the commonest presentation. All patients underwent surgical treatment with 36 (72 %) patients undergoing ligation and excision of the pseudoaneurysm. Six (12 %) patients underwent revascularization with reverse saphenous vein graft. Five (10 %) patients underwent primary repair, and three (6 %) patients were managed by putting a synthetic ePTFE graft. Postoperative wound infection was seen in 18 (36 %) patients, and 33 (66 %) patients had an uneventful recovery. In pseudoaneurysms, surgical repair at the early instance carries a favorable prognosis. If feasible, reverse saphenous vein grafting is the best conduit for repair. Synthetic vascular graft (ePTFE) can be used in case autologous saphenous vein is not available. Excision and ligation is safe, and we recommend it as the treatment of choice for infected arterial pseudoaneurysms.

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Section: Discussionsupporting

confidence: 67%

“…Repeated failed attempts to inject preparations of heroin, cocaine, and cannabis into a major upper or lower limb deep vein are likely to cause arterial or vein injury. Among injuries, femoral and brachial artery false aneurysms are being reported with increasing frequency [6].…”

Section: Introductionmentioning

confidence: 99%

Peripheral Arterial Pseudoaneurysms—a 10-Year Clinical Study

2013

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“…3 Even when patients are conscious of their diagnosis and agree to undergo surgery, they are liable to encounter problems, despite the effectiveness of antipsychotic medication. 4,5 Thus, surgeons are required to practice special perioperative management considering the mental and surgical conditions of these patients.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of colorectal cancer in patients with psychiatric disorders

Hashimoto

Isaka²,

Ishizawa³

et al. 2009

Surg Today

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“…In the peacetime periods, gas gangrene was commonly related to trauma, as well as subjects with reduced immunity. Because of this, gas gangrene is commonly present alongside malignant diseases, malnutrition, obesity, and in some specific groups, like among patients on corticosteroid therapy, patients with diabetes or heroin addicts [6], [8], [10], [11], [12], [13], [14], [15], [16], [17]. In the cases with subcutaneous or intramuscular drug injections, there is a high probability of the bacteria being administered directly into the deep tissue, and since there the conditions are anaerobic, it is ideal for clostridia proliferation [8].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Gas Gangrene in Intravenous Heroin Addict

Pavlekic

Ječmenica

Alempijević

2021

Open Access Maced J Med Sci

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BACKGROUND: Gas gangrene is a clostridium infection primarily of muscle tissue, most commonly caused by C. perfringens. Clinical diagnosis is usually made by local inspection of the wound: the infected tissue shows characteristic signs of tissue inflammation with blistered changes. The disease can starts suddenly, 4-6 hours after the injury, but most commonly the incubation period lasts 2-4 days. Without proper medical intervention, death occurs in 4-24 hours after the development of the first symptoms, but even with timely and adequate therapy, the lethality is very high (around 12%). Due to its fulminant course, in all cases with fatal outcomes, a forensic autopsy is an obligatory procedure. However, discovering the entrance gate and source of infection is not an easy task, especially in the absence of a traumatic injury. CASE PRESENTATION: Male, 27 years old, an intravenous heroin addict for about 10 years, injured his left leg in a traffic accident. He only visited the doctor after 5 days. Upon examination, it was determined that there were no externally visible injuries and no fracture, and he was given a splint immobilization for an ankle luxation. Twelve days after the accident (or 7 days after the immobilization) his mother found him unconscious. CONCLUSION: From medicolegal aspects, it’s important to have in mind even the less frequent paths of infection, in order to give an expert professional opinion on origin and cause of death.

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Infected False Aneurysms of the Limbs Secondary to Chronic Intravenous Drug Abuse: Analysis of Perioperative Considerations and Operative Outcomes

Abstract: Limb salvage with immediate revascularization is safe and achieves functionality; therefore, its use is justified. Recidivism and continued abuse is the usual consequence after discharge from hospital, making recovery difficult.

Cited by 14 publications

References 33 publications

Peripheral Arterial Pseudoaneurysms—a 10-Year Clinical Study

Peripheral Arterial Pseudoaneurysms—a 10-Year Clinical Study

Surgical management of colorectal cancer in patients with psychiatric disorders

An Unusual Case of Gas Gangrene in Intravenous Heroin Addict

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