Ligation Alone Versus Immediate Revascularization for Femoral Artery Pseudoaneurysms Secondary to Intravascular Drug Use: A Systematic Review and Meta-Analysis.

The Needle and the Damage Done: A Retrospective Review of the Health Impact of Recreational Intravenous Drug Use and the Collateral Consequences for Vascular Surgery.

Background: Infected femoral artery pseudoaneurysms (IFAPs) in Intravenous drug abusers (IVDAs) are very common nowadays with increasing incidence and controversial management strategy with little data about correlation between IFAPs criteria and limb outcome.Aim of the work: to estimate incidenceand determinants of limb salvage post arterial ligation in patients with infected pseudoaneurysms.Patients and Methods: Prospective cohortwith18 months follow up of 40 IVDA patients presented with groin pseudoaneurysms to estimate incidence and determinants of Lower Limb salvage following Arterial Ligation.Results:Duration of Intravenous (IV) addiction ranged from half a year to 30 years and affected groin use ranged from half a year to 10 years and duration of symptoms ranged from 1 to 6 weeks. Symptoms ranged between swelling in 13 cases (32.5%), pulsating mass in 12 cases (30%) and hemorrhage in 15 cases (37.5 %). DVT found in 31 cases (77.5 %). Incidence of limb salvage post arterial ligation is 75%(N 30), threatened limbs found in 25% of cases (N 10). Amputation required in 15%(N 6) and bypass in 12.5%(N 5) bypass followed by amputation in one patient. Primary patency of all constructed bypasses is 6 months for 80% (N 4) and 3 months for 20% (N 1).Viral markers showed 33 patients were HCV +ve (82.5%), 8 patients HBV +ve (20%), 9 patients HIV +ve (22.5%). There was statistically significant difference between both groups as regard duration of affected groin use, duration of symptoms, nature of presenting symptom, Pre and immediate post-operative ABI and percent of reduction between both and Level of ligation are determinants of limb salvageConclusion: Ligation and debridement with selective revascularization strategy is a safe option in IFAPs management.Incidence of limb salvage following arterial ligation is 75%. Duration of affected groin use, duration of symptoms, nature of presenting symptom, Pre and immediate post-operative ABI and percent of reduction between both and Level of ligation are determinants of limb salvage.

https://asmj.journals.ekb.eg/article_148958_fef05dc1077c69c58540d95e1c2bf8b1.pdf

Incidence and determinants of lower limb salvage following arterial ligation in infected pseudoaneurysm in intravenous drug abusers

OBJECTIVES
The study compared the outcomes between covered-stents grafting (CSG) and ligation of femoral artery (LFA) in the treatment of infected femoral pseudoaneurysm (IFP) caused by intravenous drug injection.


METHODS
From 1st January 2016 to 30th November 2021, the clinical data of patients with IFP caused by intravenous drug injection who underwent CSG (n = 31, 55.4%) and LFA (n = 25, 45.4%) are retrospectively analyzed. We compared the baseline characteristics and clinical outcomes of the two groups, including early and late mortality and morbidity.


RESULTS
A total of 56 patients were enrolled in the study, comprising 50 (89.3%) men and 6 (10.7%) women, with a mean age of 34.3 years. There was no significant difference observed between the two groups in terms of 30-day mortality (3.2% vs 0%, p = .365) and length of stay (9 [7, 12] vs 11 [8.5, 12.5] days, p = .236). However, group CSG exhibited a lower rate of intermittent claudication (0% vs 32%, p = .001), less blood loss (67.1 ± 22.5 mL vs 177.0 ± 59.8 mL, p < .001), and shorter surgery duration (57.5 ± 9.9 min vs 84.4 ± 22.8 min, p < .001) compared to group LFA. The LFA group were divided into subgroups according to the ligation site. The amputation rate of superficial femoral artery ligation group (0 vs 27.3%, p = .014) was significantly lower than common femoral artery ligation.


CONCLUSIONS
Covered-stents grafting may be a preferable treatment to LFA for IFP due to intravenous drug abuse, particularly when the entry tear is located in the common femoral artery.

Comparison between covered-stents grafting and ligation in the treatment of infected femoral pseudoaneurysm due to intravenous drug abuse.

/pdf/the-needle-and-the-damage-done-a-retrospective-review-of-the-3s0st4q1.pdf

The Needle and the Damage Done: A Retrospective Review of the Health Impact of Recreational Intravenous Drug Use and the Collateral Consequences for Vascular Surgery

Predictors of Limb Outcome Following Arterial Ligation of Infected Femoral Pseudoaneurysms in Drug Abusers

Objective Investigating the early results of percutaneous transluminal angioplasty of chronic lower-limb ischemia in patients with chronic renal failure. Background The concern that endovascular treatment of chronic lower-limb ischemia in patients with chronic renal failure is gaining popularity nowadays since the increase in morbidity and mortality rates in bypass surgery makes the procedure difficult for these patients. Patients and methods In total, 40 limbs in 40 consecutive patients (28 male, mean±SD age 59.65 ± 8.54) were analyzed, 28 with lesion, either gangrene or ulcer, and 12 with rest pain. The follow-up of healing and foot vascularity was done at regular periods and up to 1 year as ABI was not a good indicator for follow-up because of the high false results due to severe calcification. Results After 12 months, the end results of the study are as the following: 10 (25%) cases were relieved from rest pain, another 12 (30%) cases had healed lesion, and three (7.5%) cases had major amputation, 11 (27.5%) cases had return of the same complaint as preoperative by the end of 12 months. Conclusion Despite improvement in endovascular techniques and their increasing utilization for lower-extremity revascularization, peripheral revascularization in chronic renal-failure patients has not led to high limb-salvage rate. Poor outcomes may be related to the severity of ischemia on presentation, the cumulative burden of the atherosclerotic disease, and the distal location of the disease.

Mid-term outcomes of endovascular interventions of critical lower-limb ischemia in patients with chronic renal failure

Introduction: Persistent sciatic artery (PSA) is a rare anomaly of high clinical significance. Embryological, part of the sciatic artery involutes and other parts develop into the popliteal and peroneal arteries. Most cases present silent with aneurysm formation. Treatment is aneurysm exclusion with maintaining limb vasculature. Aim: Was to outline presentations and management PSA patients. Patients: First was female with bilateral pulsating gluteal masses. A bypass was done between the internal iliac and popliteal arteries because the femoral arteries were hypoplastic bilaterally. Second was 59y female presented with critical left lower limb ischemia. Femoropopliteal bypass with exclusion of the aneurysm was done. Third patient was 52y male with right painful pulsating gluteal mass with hypoplastic femorals. Conclusions: PSA is a rare vascular anomaly. Treatment depends on clinical and angiography presentation. Usually surgery is preferred. PSA awareness is in favor to appropriate management.

Persistent Sciatic Artery Aneurysm: Cases Series and Review of Literatures

Blunt trauma of the brachial artery (BA) in pediatric age is often associated with neurological and orthopaedic injuries. Acute ischemic hands warrant immediate exploration, but the management of warm-pulseless hands following elbow trauma is controversial. This study evaluates the role of conservative treatment of blunt BA injuries in children with non-threatened hands. Eleven children with blunt trauma onto the BA having warm-pulseless hands were studied retrospectively. After a mean follow-up period of 2.5 ± 0.9 years, all cases had thorough clinical examination and duplex scan to assess the treatment outcomes. At the end of follow-up period, all subjects had well-perfused hands with intact wrist pulses. The duplex scan revealed those who had interposition grafts to be patent and one case had an aneurysmal dilatation. There was no statistical significance difference between affected and healthy forearms regarding the mean peak systolic velocity at the wrist, affected side was 62 ± 0.82 cm/s versus 68 ± 0.57 cm/s for opposite side ( p -value = 0.14). Patients with blunt BA trauma and warm-pulseless hands could be managed safely with conservative treatment, leaving surgical exploration for those who did not regain pulses after 48 hours. Duplex ultrasound can safely verify the patency of surgical repair and can be used for surveillance to detect future complications.

Conservative Approach is Safe for Perfused-Pulseless Hands Following Blunt Brachial Artery Injury in Children.

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Papers

Predictors of Limb Outcome Following Arterial Ligation of Infected Femoral Pseudoaneurysms in Drug Abusers

Mid-term outcomes of endovascular interventions of critical lower-limb ischemia in patients with chronic renal failure

Persistent Sciatic Artery Aneurysm: Cases Series and Review of Literatures

Conservative Approach is Safe for Perfused-Pulseless Hands Following Blunt Brachial Artery Injury in Children.