PSEUDOANEURYSMS IN INTRAVENOUS DRUG ABUSERS

Abstract

Background: Intravenous drug abuse can lead to vascular complications, most frequent of which is pseudoaneurysm. These
pseudoaneurysms (false aneurysms) are prone to rupture, leading to profuse hemorrhage and death. Objective: To evaluate
pseudoaneurysms in intravenous drug addicts for the site, mode of presentation, management and outcome. Design: Descriptive study.
Place and duration of study: Surgical unit I, Combined Military Hospital, Rawalpindi. Surgical unit 2, Combined Military Hospital, Lahore.
January 2006 to September 2010. Subjects and methods: All cases of pseudoaneurysms in intravenous drug addicts who presented to a
single vascular surgeon, between 1st January 2006 and 30th September 2010, were evaluated for site, mode of presentation, treatment and
the outcome. Surgical procedures included excision of pseudoaneurysm with interpositioning of graft, repair of vascular rent, ligation of vessel
and debridement. All cases were referred to psychiatrist for management of drug addiction. Results: Total 12 cases of pseudoaneurysms due
to IV drug abuse were included in our study. Arteries affected included 9(75%) common femoral arteries (CFA). In 3(25%) cases, both common
femoral artery and vein were involved with arteriovenous fistula between them. There was 1(8.3%) pseudoaneurysm each of external iliac
artery, superficial femoral artery and brachial artery. Nine cases (75%) presented with recurrent hemorrhage from a swelling while in 3(25%)
cases there was swelling with no history of hemorrhage. In 7(58.3%) cases, repair/grafting, while in 5(41.6%) cases ligation and debridement
was done. There was seroma formation in 1(8.3%) case after excision and grafting. In none of the cases, in which artery was ligated, critical limb
ischaemia occurred. Conclusions: Common femoral artery is the most frequent site of pseudoaneurysms in IV drug abuse. In those cases
where vascular reconstruction is not possible due to extensive skin necrosis or infection, ligation of affected vessel is not only a life saving
procedure but a safe option also.