Vascular lesions in intravascular drug abusers in Guilan, north of Iran

Intravenous drug abuse is an increasing social and health problem. Repeated injuries to the veins, injection of some types of insoluble substances, and needle sharing habits result in various complications. Increasing incidence of major vascular complications has been reported worldwide. The objective of this study was to determine the epidemiology of vascular lesions in drug abusers. Medical records of 50 patients who were consecutively admitted to the surgical wards, presenting with a pulsatile mass, infection of the injection site, or venous thrombosis in the groin or cubital fossa were retrospectively reviewed. Of 50 patients studied, 88% were males and 12% were females. Most of the drug abusers were young. Eighty percent of the patients had an infected injection site in the groin, 12% in the cubital fossa, and 8% in other sites. Seventy-six percent of the patients had been injecting drugs for 10 years and the remaining 24% for more than 10 years. Pseudo-aneurysm was the final diagnosis in 27 (54%) patients. In females, the vascular lesions diagnosed were pseudo-aneurysm in four, deep venous thrombosis in one, and arterio-venous fistula in another patient. Among male patients, pseudo-aneurysm was present in 23 (52%), venous thrombosis in eight (18%), necrotizing fasciitis in three (7%), vascular abscess in two, and arterio-venous fistula in one (5%). Most of the vascular lesions involved the groin or cubital fossa and presented as a pulsatile mass. They may benefit from early referral to a vascular surgery unit. Infected pseudo-aneurysm is the most common pathology in our population and the best management for all infected pseudo-aneurysms is the ligation of the artery.