Vascular Injuries in Intravenous Drug Addicts—A Single-Center Experience

Ilic, Anica; Stevanović, Ksenija; Pejkić, Siniša; Marković, Miroslav; Dimić, Andreja; Sladojević, Miloš; Davidović, Lazar

doi:10.1016/j.avsg.2020.02.041

Cited by 11 publications

(22 citation statements)

References 27 publications

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“…Although an uncommon complication, previous studies have reported amputation in patients with complicated IDU. 18,19 Patients who went on to develop postoperative infections were also more likely to undergo amputation (13.1% of cases with infection resulted in amputation versus 3.1% without infection), emphasizing the importance of infection prevention.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Surgical Site Infections After Fasciotomy in Patients With Compartment Syndrome

Merchan

Ingalls²,

Garcia³

et al. 2022

JAAOS Glob Res Rev

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Introduction:Fasciotomy is the standard of care to treat acute compartment syndrome (ACS). Although fasciotomies often prevent serious complications, postoperative complications can be notable. Surgical site infection (SSI) in these patients is as high as 30%. The objective of this study was to determine factors that increase the risk of SSI in patients with ACS.Methods:A retrospective review of 142 patients with compartment syndrome over 10 years was done. We collected basic demographics, mechanism of trauma, time to fasciotomy, incidence of SSI, use of prophylactic antibiotics, and type and time to wound closure. Statistical analysis of continuous variables was done using the Student t-test, ANOVA, multivariable regression model, and categorical variables were compared using the chi-square test.Results:Twenty-five patients with ACS (17.6%) developed infection that required additional treatment. In the multivariate regression model, there were significant differences in median time to closure in patients with infection versus those without, odds ratio: 1.06 (Confidence Interval 95% [1.00 to 1.11]), P = 0.036. No differences were observed in infection based on the mechanism of injury, wound management modality, or the presence of associated diagnoses.Conclusion:In patients with ACS, the time to closure after fasciotomy is associated with the incidence of SSI. There seems to be a golden period for closure at 4 to 5 days after fasciotomy. The ability to close is often limited by multiple factors, but the correlation between time to closure and infection in this study suggests that it is worth exploring different closure methods if the wound cannot be closed primarily within the given timeframe.

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Section: Discussionmentioning

confidence: 99%

Factors Associated With Surgical Site Infections After Fasciotomy in Patients With Compartment Syndrome

Merchan

Ingalls²,

Garcia³

et al. 2022

JAAOS Glob Res Rev

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“…Femoral vessels in the femoral triangle are convenient routes for drug administration due to their superficial position. Vascular injuries in drug abusers are common in this area followed by brachial and other vessels [4,5]. The management of pseudoaneurysm is quite a dilemma for vascular surgeons around the globe.…”

Section: Discussionmentioning

confidence: 99%

“…Repeated injury to the vessel wall leads to the formation of hematoma in surrounding tissue, resulting in the development of a pseudoaneurysm (false aneurysm), which is distinguished from true aneurysm as it lacks all three typical elements of the arterial wall [4]. The typical femoral artery pseudoaneurysm presentation includes a pulsatile mass, infection, and oozing of blood, with or without peripheral vascular compromise, and most lethal is massive bleeding [5].…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Femoral Artery Pseudoaneurysm in Intravenous Drug Abusers Managed at a Tertiary Care Center

DDin¹,

Berlas²,

Rehman³

et al. 2021

Cureus

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The aim of this study was to assess the effects of ligation and excision of femoral artery pseudoaneurysm without revascularization in intravenous drug abusers presenting in the tertiary care center. MethodsThis was a retrospective study conducted at Shaheed Mohtarma Benazir Bhutto Institute, Karachi, Pakistan, and included 119 patients admitted for vascular injuries of the groin between June 2016 and June 2020. Data collected from the hospital's medical records included all intravenous drug addicts presented with mass near or at groin area only, while other pseudoaneurysm locations secondary to vascular trauma, arteriovenous fistula, and hemodialysis were excluded. SPSS Version 20.0 (IBM Corp., Armonk, NY, USA) was used for data analysis. ResultsThis study included 119 patients, all of whom presented and admitted to the Accident and Emergency Department, with a mean age of about 32 years ± 11.34 years and a mean duration of addiction of 2.47 years ± 1.37 years. Males constituted 83.2% of the patients, while females constituted 16.8%. The left femoral artery was affected more commonly than the right femoral artery, with an average of 75.6% and 24.4%, respectively. The most common presentation was bleeding from ruptured pseudoaneurysm (76.5%) and oozing with pulsatile mass (17.6%), while infected pulsatile swelling and misdiagnosis were uncommon. After surgical intervention, limb salvage was 95.8%, whereas mortality and amputation rate were 2.5 % and 1.7%, respectively. ConclusionThe optimal management of femoral artery pseudoaneurysm in intravenous drug addicts is ligation and excision of the pseudoaneurysm without revascularization.

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“…In addition, intravenous drug use significantly increases the rate of injury in young people because it's easy to reach. 11 Amputation risk may be more common in lower extremity artery injuries than upper extremity artery injuries. The risk of amputation is not only the localization of the injury; it is also associated with comorbid bone fracture, nerve injury and massive tissue damage.…”

Section: Discussionmentioning

confidence: 99%

Current results of arterial injuries seen at femoral and popliteal arteries in civil society

2020

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Background: Lower extremity arterial injuries caused by penetrating or fired-gun trauma may result in limb or loss of life. Early intervention has critical importance. The aim of this study was to investigate the importance of early intervention and outcomes.Methods: We retrospectively reviewed the data on 144 patients (18 females, 126 males) who were treated in Istanbul Medipol University Hospital between January 2016 to 2018. All patients had an arterial injury at level of femoral and popliteal arteries. Standard statistical methods were used for data analysis.Results: Revascularization was performed to all 144 (18 females, 126 males) patients. Autologous saphenous vein graft interposition was performed in 96 patients. End-to-end repair was performed in 39 patients. 9 patients underwent a polytetrafluoroethylene graft (8 mm ringed) interposition.Conclusions: All viable limbs should be revascularized rapidly. The primary goal is to provide bleeding control rapidly and to prevent the prolongation of ischemic time. It should be kept in mind that in addition to surgical technique, fasciotomy may be required in arterial injuries with ischemic time of more than 6-8 hours.

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Vascular Injuries in Intravenous Drug Addicts—A Single-Center Experience

Cited by 11 publications

References 27 publications

Factors Associated With Surgical Site Infections After Fasciotomy in Patients With Compartment Syndrome

Factors Associated With Surgical Site Infections After Fasciotomy in Patients With Compartment Syndrome

Outcomes of Femoral Artery Pseudoaneurysm in Intravenous Drug Abusers Managed at a Tertiary Care Center

Current results of arterial injuries seen at femoral and popliteal arteries in civil society

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