Surgical Management of Infected Pseudoaneurysms in Intravenous Drug Abusers: Single Institution Experience and a Proposed Algorithm

Abstract

Pseudoaneurysm from intravenous drug abuse continues to pose significant challenges to surgeons worldwide, ranging from an accurate diagnosis to the choice of surgery. The aims of surgery must be to achieve adequate débridement and control infection and hemorrhage. Any associated postoperative complications must be identified and dealt with.

Foot drop with a popliteal artery aneurysm due to heroin use: A case report

“…Postoperative complications included claudication, digital gangrene, surgical site infection, and hematoma. [15] In our case, pseudoaneurysm and hematoma were treated surgically; however, peroneal nerve damage developed either due to the pressure of hematoma or iatrogenically. Pseudoaneurysm due to heroin use in the popliteal artery is very rare; however, foot drop caused by peroneal nerve damage along with complex regional pain syndrome type II is seen for the first time in the literature.…”

“…The most common site for aneurysm was shown to be brachial artery, and only one patient had a popliteal artery aneurysm. In a study by Tan et al, [15] 15 patients who had pseudoaneurysms due to IV substance use were retrospectively analyzed. Of these patients, pseudoaneurysms were found in the femoral artery in 13 patients and in the brachial artery in two patients.…”

“…In pseudoaneurysm cases, the initial symptoms are usually pain, swelling, and erythema on the injection site. [9,10,12,15,17] Patients are usually admitted to the emergency clinic with massive bleeding, and patients with pain and swelling, but no bleeding on the injection site should be investigated for pseudoaneurysms and possible drug use. [15] It is recommended to use Doppler ultrasound and computed tomography for the definite diagnosis.…”

Infected femoral pseudoaneurysms in intravenous drug abusers: a decade of experience from a Singapore tertiary centre

“…Although there are no published guidelines on the recommended management for this group of patients, most vascular units regard arterial ligation with wound debridement as the first-line surgical treatment. (10)(11)(12) The principles of surgery, for these patients, are adequate debridement of necrotic tissue, control of haemorrhage and preservation of distal circulation, when possible.…”

Acute Upper Limb Ischemia Due to Delayed Presentation of a Brachial Artery Pseudoaneurysm Post-Venipuncture

“…Symptoms of sepsis with purulent discharge can occur in infected BAPs, in the context of chronic intravenous drug abuse. 11 Median nerve and radial nerve neuropathy from mass effect of a BAP has been described, even when the BAP is not clinically apparent. 4,12,13 As such, suspicions of a pseudoaneurysm should be raised with such symptoms, especially post-arterial or venous access.…”