Ruptured mycotic aneurysms

Abstract

Two cases of ruptured mycotic aneurysms in intravenous drug abusers are presented. The pathogenesis, clinical presentation, radiological diagnosis, and management of mycotic aneurysms are discussed. Early diagnosis and therapy are required to salvage these patients.

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

“…Urgent surgical exploration for active bleeding 9,14 and hemodynamic instability 13,17 is often indicated, as in 38% of our patients. It is clear that clinical suspicion of any IFA is based on history and careful physical examination; 7,13-15,19 however, a defi nite diagnosis is usually confi rmed by DUS 5,7,14,19,21,22 or DSA. [3][4][5]8,9,[15][16][17]21,22 "Simple" incisions and drainage of IFAs by the unwary surgeon usually result in unexpected bleeding 3,14 and even circulatory shock and death; however, negative aspirates do not preclude false aneurysms and can delay the diagnosis.…”

“…Moreover, deep vein thrombosis of the lower extremities was found in 68% of the patients with fa-IFA. 25 Symptoms and signs of systemic infection, including fever, 2,3,12,15,[17][18][19]22,25,27,28 an elevated white blood cell count, 2,12,15,17,18,22,28 bacteremia, [2][3][4]8,19,22 and even sepsis, 2,3,5,8,9,14 often accompany the painful pulsatile upper or lower limb swelling. Thus, systemic infl ammatory response does not always correlate with focal symptoms, as seen in our study.…”

“…Cellulitis or abscess, produced by contaminated needles, can also produce vessel wall rupture if it is close to a vascular structure. 4,10,15,22 Chemical arteritis is another possible mechanism of vessel wall injury causing necrosis and subsequent disruption. 2,7 Septic embolization within the arterial lumen from bacterial endocarditis, 3 a common complication in drug addicts, also causes gradual weakening with enlargement of the arterial wall and aneurysm formation.…”

“…2,7 Septic embolization within the arterial lumen from bacterial endocarditis, 3 a common complication in drug addicts, also causes gradual weakening with enlargement of the arterial wall and aneurysm formation. 17,22 The easily accessible superfi cial venous network of the cephalic, basilic, and saphenous veins soon becomes sclerotic 3,17 after repeated punctures in drug abuse. 1,23 The same thing happens with more distal veins progressively searched out by the long-term addict.…”

“…When alternative routes of parenteral drug abuse are exhausted, the groin, 1,5,12,14,21 antecubital fossa, 1,21,24 and even the axilla 21 and neck are injected, so eventually complications will be brought to the vascular surgeon's attention. Although most infected false aneurysms (IFAs) attributed to repeated punctures involve the groin, 2,3,7-9, [13][14][15][16][17]19,21,22,[25][26][27] which is the easiest and preferred "anatomic site" used by the drug addict, 15 other locations such as the subclavian, 13 axillary, 28 brachial, 3,13,19,22,25 radial, 15,19 external iliac, 8 popliteal, 19,22 and even the carotid arteries have been reported as target sites of similar lesions.…”