Management of brachial artery pseudoaneurysms secondary to drug abuse

Arterial pseudoaneurysm secondary to parenteral drug abuse poses a difficult problem to vascular surgeons. This study prospectively evaluates the outcome of surgical treatment for brachial artery pseudoaneurysms secondary to drug abuse. From February 1996 to July 2003, all brachial artery pseudoaneurysms secondary to drug abuse as diagnosed by duplex imaging were recruited for the study. Aneurysm excision, ligation, and radical debridement along with revascularization by axial reanastomosis were performed for all patients except one with chronic degenerative fusiform aneurysm, who received aneurysm resection and interposition reverse saphenous vein graft. Upper limb arterial flow was evaluated clinically and with hand-held Doppler in the perioperative period and during subsequent follow-up. During the study period, nine consecutive patients presented with cubital fossa swelling following deliberate drug arterial injections. Two of them suffered from thromboembolic complications and were managed conservatively by heparinization. Seven patients (six male, one female), aged 32-53, were confirmed to have brachial artery pseudoaneurysms by duplex scan and recruited for data analysis. Pseudoaneurysms ranged 10-40 mm in size. One ex-heroin abuser, who presented with median nerve palsy, underwent aneurysm resection and reversed saphenous vein interposition. The other six patients presented with painful pulsatile cubital fossa swellings. They underwent aneurysm resection, extensive debridement, and primary axial reanastomosis. There were no perioperative procedure-related complications. With an average follow-up of 38.7 months, no recurrences or neurovascular complications were detected. Routine revascularization by aneurysm resection and axial anastomosis for brachial artery pseudoaneurysm secondary to drug abuse is a safe, effective approach with low associated morbidity.