Infected femoral pseudoaneurysms from intravenous drug abuse in young adults

Abstract

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.

Prevalence and Characteristics of Femoral Injection among Seattle-Area Injection Drug Users

“…9 Femoral injection may be preferred over peripheral injection not only due to difficulty finding other veins, but also due to access that is quick (to avoid detection), easy (due to large size of femoral vein and development of a sinus tract) and reliable (less likely to miss the vein altogether or have to repeat injection), a possibly superior "rush," and the lack of visible track marks when clothed. 9 On the other hand, femoral injection has been associated with a number of deleterious medical consequences, including deep vein thrombosis, 10 septic thrombophlebitis, 11 abscesses, 12 damage of the femoral nerve, 13 femoral artery necrosis, 14 and arteriovenous fistula 5 or pseudoaneurysm. 15 It is not known whether the increase in femoral injection observed in the UK is an isolated phenomenon or more widespread.…”

Ruptured pseudo-aneurysm of a femoral artery in a drug abuser revealed by post-mortem CT angiography

“…This lesion may occur after arterial trauma resulting from accidental or intentional intraarterial drug injection. This most commonly occurs when peripheral veins are inaccessible [1,8,16]. Repeated punctures of the femoral artery can lead to abscess formation and epithelisation of the arterial wall, resulting in the formation of a pseudoaneurysm.…”

“…These latter complications can be limb or even lifethreatening, with difficult and controversial clinical management [4]. The femoral localization of a pseudo-aneurysm has been reported in clinical practice [5][6][7][8], but a post-mortem diagnosis complete with post-mortem computed tomography angiography (PMCTA) has not been presented up until now.…”

Intraarterial Injection of Drugs of Abuse into Femoral Artery: Case Report and Review of the Literature

“…Injection drug users traditionally use veins for drug delivery but arteries are occasionally used intentionally or inadvertently. Owing to the clandestine nature of intravenous drug abuse femoral region is often used as an access door to venous system [4]. Accidental intra-arterial injection of drugs in common femoral artery is a sporadic complication in intravenous-drug addicts.…”