Treatment of arterial lesions in drug addicts

Arterial complications among drug addicts are rare. Their appearance can engage the vital prognosis of the patient and present a major risk of amputation. The injection of products with high cellular toxicity induces septic necrosis of the arterial wall and adjacent tissues. It is frequently responsible for acute hemorrhage. The data in the literature concerning surgical treatment are discussed. The goal of our study was to analyze the immediate and midterm results of the surgical management of these arterial lesions.

Between January 2005 and April 2012, 31 drug addicts (4 women; 31.4 ± 7.2 years) presenting with 33 arterial lesions were treated. They presented with a humeral (n = 15), femoral (n = 13), or axillar (n = 3) false aneurysm. Two patients had an arterial thrombosis. The clinical manifestations were an acute hemorrhage (n = 16), a septic syndrome (n = 7), a pulsatile mass (n = 6), and an acute ischemia (n = 4). In situ revascularization was carried out in 20 cases, in 15 patients with a bypass (9 venous and 6 prosthetic), in 2 with a venous patch, in 2 by direct suture, and in 1 by transposition of the superficial femoral artery in the deep femoral artery. Extra-anatomic bypass revascularization was performed in 6 cases (4 venous and 2 prosthetic). The other techniques used were ligature (n = 5) and medical care (n = 2). Two patients had an additional procedure with a musculocutaneous epigastric pedicled flap in order to fill the loss of substance.

The early rate of reinterventions was 38.7% at 30 days (12 patients), because of a suture line hemorrhage related to sepsis (n = 6), a bypass thrombosis (n = 5), and of acute ischemia after a arterial ligature. These complications occurred mainly on extremities, having had an anatomic revascularization (n = 9). Six extra-anatomic revascularizations had to be performed in second intention. The average follow-up was 8.6 months (range: 1-73.5 months), and 15 patients were lost to follow-up at 6 months. The patients were followed by duplex ultrasonography and/or angioscanner. Primary and secondary actuarial patencies at 1, 3, and 6 months were 61%, 46%, 46%, and 91%, 81%, and 71%, respectively. The rate of salvage of extremities was 100%.

Our study reveals the difficulty of the management of these arterial lesions. The local and general septic process is primarily responsible for early complications. Arterial restoration with extra-anatomic bypass makes it possible to be distant from the infection. This technique can be associated with a covering flap.