The Management of Mycotic Femoral Pseudoaneurysms in Intravenous Drug Abusers

Peirce, Colin; Coffey, Juliana; O’Grady, Helen; Aly, Sayed; O’Malley, K; O’Donohoe, Martin K.

doi:10.1016/j.avsg.2008.08.013

Cited by 36 publications

(28 citation statements)

References 14 publications

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“…240,281,[288][289][290][291] Postoperative ischemia and claudication occurred in 33% to 97% of patients, hemorrhage in 18% to 44%, and limb amputation in 5% to 33%. 240,281,[288][289][290][291] Ligation only of an MA involving the femoral artery is associated with a higher risk of postoperative claudication or amputation than with ligation of MA in the superficial femoral or tibial arteries. 163,281,285 Popliteal artery ligation carries a risk of amputation or severe chronic ischemia.…”

Section: Managementmentioning

confidence: 99%

See 1 more Smart Citation

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

373

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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Section: Managementmentioning

confidence: 99%

“…Ultrasonography or CTA may be considered for the diagnosis. 162,281,288 Ultrasonography is useful to distinguish cellulitis or abscess from MA. 163 To-and-fro filling of a pseudoaneurysm demonstrated by Doppler ultrasonography is suggestive of an MA in susceptible patients.…”

Section: Clinical Presentationmentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

373

307

View full text Add to dashboard Cite

show abstract

“…An Irish study in 2009 included four IVDAs who received thrombin injections for their infected femoral pseudoaneurysms. (17) The patients in the study were thought to be suitable, as they presented early and had small diameter pseudoaneurysm necks.…”

Section: Resultsmentioning

confidence: 99%

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

Samarakoon

Tan

et al. 2021

smedj

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“…Simple ligation of the external iliac or CFA without revascularization represents the most common treatment approach. Such a management however carries considerable risk of severe claudication, critical ischemia, and subsequent amputations [4] and therefore should be preserved for cases where revascularization cannot be applied.…”

Section: Discussionmentioning

confidence: 99%

Management of a Complicated Ruptured Infected Pseudoaneurysm of the Femoral Artery in a Drug Addict

Psathas

Lioudaki

Karantonis

et al. 2012

Case Reports in Vascular Medicine

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Infected pseudoaneurysm of the femoral artery represents a devastating complication of intravenous drug abuse, especially in the event of rupture. Operative strategy depends upon the extent of arterial injury and the coexistence of infection or sepsis. Options range from simple common femoral artery (CFA) ligation to complex arterial reconstruction with autologous grafts (arterial, venous, or homografts). We report herein the management of a 29-year-old male patient who was urgently admitted with a ruptured pseudoaneurysm of the right CFA, extending well above the inguinal ligament. Multidisciplinary approach with multiple arterial reconstructions and subsequent coverage of the tissue defect with a rectus abdominis musculocutaneous flap transposition was performed.

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The Management of Mycotic Femoral Pseudoaneurysms in Intravenous Drug Abusers

Cited by 36 publications

References 14 publications

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

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

Management of a Complicated Ruptured Infected Pseudoaneurysm of the Femoral Artery in a Drug Addict

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