Color coded duplex sonography of inguinal vessels in i.v. drug addicts

During recent years increasing numbers of intravenous drug addicts with severe damage to the groin vessels were examined in our angiological ultrasound laboratory. The value of color duplex sonography for the clinical evaluation of these findings is the subject of the present study.

Over the course of six years every drug addict admitted to our hospital who either complained of pain or discomfort in the inguinal region or showed conspicuous clinical findings in this area was examined in our ultrasound laboratory. First by B-mode, the diameter, wall structure and compressibility of the vessels were evaluated and the surrounding tissue was checked for abnormalities. Then the blood flow of the femoral vessels was examined by color coded duplex. If an abscess was suspected, a computed tomography of the groin was obtained before surgery in most cases.

A total number of 77 patients was examined with pathologic results in all cases. The most frequent finding was venous thrombosis: In 63 patients complete thrombotic occlusion of the femoral vein at the injection site was observed. We registered 14 partial thromboses. 30 patients showed vessel wall alterations to variable extents in which 23 cases referred to veins and 10 cases to arteries. 7 patients showed an occlusion of the femoral artery. In 4 patients we found a false aneurysm and 3 had an arteriovenous fistula. Chronic tissue alterations were present to a certain extent in all cases rendering evaluation frequently difficult. Especially problematic to evaluation were those 34 patients where one or more surgical interventions had been performed previously. The results of an additional computed tomography had little effect on the therapeutic decisions. In 11 patients an abscess incision had to be done during the course of their hospital stay.

Extensive damage of the groin vessels is seen in i.v. drug addicts. There is no other patient group with such a diversity of different findings. In almost every case these findings involve veins and arteries as well as the surrounding tissues.