Outcome after Ligation of Infected False Femoral Aneurysms in Intravenous Drug Abusers

Gan, John; Leiberman, D. P.; Pollock, John G.

doi:10.1053/ejvs.1999.0976

Cited by 41 publications

(20 citation statements)

References 8 publications

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“…In these cases, surgical management with wound debridement to control sepsis and arterial ligation to protect from catastrophic haemorrhage is a recognised and generally accepted surgical technique. [3][4][5][6] The relatively low number of amputations performed during the index admission in this series (5.5% versus 10% described in previous studies 4,5,7 ) would appear to continue to justify this approach. Unfortunately, in some cases limbs will be lost.…”

Section: Discussionmentioning

confidence: 55%

“…In previous series describing intervention and outcome following presentation with mycotic pseudoaneurysm of the common femoral artery, the mean age of patients has ranged from 25 to 33 years. [3][4][5][6] In these patients, a policy of exploration with drainage of sepsis, debridement of non-viable tissue and ligation of the common femoral artery on an urgent/emergent basis (dictated by active haemorrhage and extent of local sepsis) has been the local standard of care. The evidence available suggests that this is safe and effective, with avoidance of secondary haemorrhagic complications that can result from arterial reconstruction through an infected field, with acceptable limb salvage reported.…”

Section: Introductionmentioning

confidence: 99%

“…The evidence available suggests that this is safe and effective, with avoidance of secondary haemorrhagic complications that can result from arterial reconstruction through an infected field, with acceptable limb salvage reported. [3][4][5][6] However, in some series, major limb amputation rates of up to 10% have been reported. 4,5,7 There is a high prevalence of cigarette smoking in IVDU.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

et al. 2017

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“…Qui et al found that most patients with a drug use history of over 5 years had no claudication symptoms at all [9] . It is believed that patients with longstanding intravenous drug abuse develop an adequate collateral blood supply and as they are frequently young are often free from underlying atherosclerotic disease [10] thus less likely to require a subsequent amputation following ligation of the common femoral artery. Studies demonstrate the incidence of major amputation in patients presenting with infected femoral pseudoaneurysms is in the region of 30% [4] , [11] , compared with figures as high of 86% of military patients who have required CFA and SFA and SFA ligation following trauma [4] .…”

Section: Discussionmentioning

confidence: 99%

“…All the patients in this series were initially treated with broad-spectrum antibiotics, which were later, adjusted according to positive culture growths and close liaison with the microbiology team. Despite Staphylococcus aureus being the most common causative organism [10] , [20] the wider literature advises early administration of broad-spectrum antibiotics to cover for more atypical organisms such as Campylobacter and Listeria species [21] which should be considered as these patients may well be immunosuppressed.…”

Section: Discussionmentioning

confidence: 99%

Management options in the treatment of femoral pseudoaneurysms secondary to intravenous drug abuse: A case series

Rammell

Kansal

Bhattacharya

2017

International Journal of Surgery Case Reports

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HighlightsInfected femoral pseudoaneurysms are a common presentation in intravenous drug users with little consensus as to their optimum management.Excision and ligation of the femoral artery without revascularisation is the most common operative intervention.With the identification and optimisation of suitable patients, revascularisation can be performed in the emergency setting.Current endovascular approaches appear to be used only as a bridge to a future definitive revascularisation procedure.Ligation of the common femoral artery without revascularisation is both safe and effective as most patients will avoid critical ischaemia.

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Femoral artery ligature for treatment of infected groin pseudoaneurysm in injected drug abusers

2022

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Drug addiction is a major social and medical concern. Infected groin pseudoaneurysm (IGP) is the result of direct arterial needlestick injury associated with contamination of the arterial wall or peri-arterial area by the injection equipment. Femoral artery (FA) ligation with extensive debridement is an alternative to direct revascularization in an area of sepsis. In case of femoral bifurcation free of infection or in case of isolated FA below the femoral artery of thigh involvement, a simple ligation of the FA is performed. Ligation of each femoral vessel is indicated in case of extension of the infection to the femoral bifurcation. Proximal ligation is performed on the proximal part of the FA. Distal ligation is performed on the proximal part of the deep artery of thigh and the FA below the origin of the deep artery of thigh. Ligation is effective and represents an appropriate method to control hemorrhage and sepsis syndrome in IGP.

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Outcome after Ligation of Infected False Femoral Aneurysms in Intravenous Drug Abusers

Cited by 41 publications

References 8 publications

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

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

Management options in the treatment of femoral pseudoaneurysms secondary to intravenous drug abuse: A case series

Femoral artery ligature for treatment of infected groin pseudoaneurysm in injected drug abusers

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