Mycotic pseudoaneurysms due to injection drug use: a ten-year experience.

摘要: Background Arterial injury and infection due to repetitive injection drug use can result in mycotic pseudoaneurysm predisposing hemorrhage, distal embolism, limb loss, death. We hypothesized that debridement of the infected artery, followed by immediate vascular reconstruction, results successful salvage these patients. Methods The setting was a county hospital. A retrospective review all patients diagnosed with lower extremity pseudoaneurysms Departments Surgery Radiology between 2000 2009 conducted. Outcome measures were patient characteristics, site(s) lesion, type imaging, operation, length hospital stay, complications. Results Sixteen had 17 pseudoaneurysms. One two same region separated period 10 months. Culture wall first not performed. second culture positive. 15 remaining Nine men, median age group 37 years. Common femoral most frequent (76%). Symptoms included swelling (94%), pain (82%), erythema (75.6%). rapidly expanding pulsatile expansile mass present four Computed tomography percutaneous angiography done seven patients, respectively, diagnostic cases studied. Resection reconstruction autologous vein common procedure (seven), cadaveric grafting (four), synthetic (two), ligation primary repair (two). Muscle flaps used 76.5% cases. Complications anastomotic dehiscence (n = 3), acute thrombosis 1), ischemia abscess compartment syndrome 1). Three required reconstruction. ultimately an amputation. No postoperative deaths occurred. Methicillin-resistant Staphylococcus aureus cultured from 13 16 arterial walls. Conclusion is predominant organism causing aneurysms superficial arteries owing at San Francisco General Hospital. Wide artery in-line reversed saphenous or cryopreserved allograft safe effective method treatment. Long-term follow-up studies are needed determine durability this