Vascular complications among intravenous drug addicts

Abstract

Introduction: Drug addiction is one of the major medico-social problems in many countries. Intravenous injection is the most dangerous but one of the favorite drug assumption modality. Each drug injection carries a risk of vascular lesion. The literature describes many vascular complications among intravenous drug addicts such as venous thrombosis, septic thrombophlebitis, artery necrosis, arteriovenous fistula, sinus track, mycotic aneurysm, dissecting hematoma and pseudoaneurysm formation. The aim of this study is to identify most common patterns of vascular injuries and to analyze their treatment modalities among intravenous drug addicts. Materials and Methods: Data of 24 patients hospitalized during the six years period with vascular complications after intravenous drug injections were retrospectively analyzed. Results: Twenty (83.3%) pts had an age up to 30 years. Vessels involvement was confirmed by imaging exam: angiography (n=2) or vascular ultrasound (n=22). The types of vascular complications (all at the level of lower limbs) which serve as indications for hospitalization of drug addicts are listed as follows: (1 )4 patients have been identified with infections of femoral artery’s pseudoaneurysm, (2) 1 patient had an aneurysm of popliteal artery, (3) deep venous thrombosis was seen in 11 patients, (4) venous inguinal sinus track with haemorrhage - in 3 patients, (5) postthrombotic syndrome - in 5 patients. Two patients were diagnosed with concomitant human immunodeficiency virus causing the acquired immunodeficiency syndrome, and 54.16% had viral hepatitis. Four drug addicts developed hemorrhagic shock due to profuse hemorrhage from the level of vascular lesion. In one patient with femoral arterial pseudoaneurysm emergent iliofemoral bypass using autogenous vein was performed. In other three pts triple arterial ligation has been primary selected to solve the cases. All inguinal venous sinus tracks complicated with profuse bleeding were closed by applying continuous suture using synthetic non-absorbable thread - polypropylene 5/0. Remained patients received conservative treatment. High amputation of affected limb was necessary in one drug addict. There were no cases of death during hospitalization. Conclusion: The primary goal of surgical treatment of vascular complications in intravenous drug addicts should be prevention of life-threatening clinical conditions. Arterial ligation is an acceptable curative option in cases of erupted/infected femoral artery pseudoaneurysm in drug addicts. Physicians should have a high index of suspicion for vascular problems among this contingent of patients, because they often neglect their illnesses and become difficult to treat.