Vascular disorders related to injecting drug use

Abstract

Introduction. Intravenous illicit drug abuse is a significant problem in modern societies, with continuously increasing frequency and a subsequently increasing incidence of vascular complications. Aim of the study. Was to review the potential vascular complications that could occur in patients using recreational drugs and to evaluate possible treatment regimes. Materials and methods. We conducted a retrospective study that included 30 intravenous drug addicts, hospitalized during a seven years period with vascular complications at Department of general surgery, Municipal Clinical Hospital no.1 (Chisinau). Results. Twenty-two (73.4%) patients were younger than 30 years. Twenty-eight (93.4%) cases were diagnosed based on clinical examination and duplex ultrasound, while another 2 (6.6%) – using CT-angiography. The following types of vascular complications were found: in 12 (40%) cases – deep venous thrombosis; in 7 (23.4%) cases – femoral artery pseudoaneurysm, in 5 (16.7%) – postthrombotic syndrome, in 5 (16.7%) – venous inguinal sinus track with hemorrhage, and in 1 (3.3%) case – infected aneurysm of popliteal artery. The treatment was conservative in 14 (46.7%) cases, but 16 (53.3%) patients required emergent surgical intervention for life-threatening conditions. Surgical procedures performed in analyzed group were the following: vascular reconstruction of femoral artery using an autogenous vein graft, triple ligation of femoral artery, closing the inguinal sinus track with definitive hemostasis, and primary above the knee amputation of lower extremity. Conclusions. Prevention of life-threatening clinical conditions should be the primary goal of the surgical treatment of vascular complications in intravenous drug addicts. The infected arterial pseudoaneurysm with profuse external hemorrhage is the most dangerous vascular complication, the optimal management being arterial ligation. Revascularization of affected limb should be reserved only for patients who do not tolerate resulting ischemia