Leriche Syndrome with Digital Gangrene: Is Aortic Bypass Grafting Safe in Intravenous Drug Abusers? A Case Report and...

Area of Science:

• Vascular Surgery
• Infectious Disease Prevention
• Patient Management

Background:

• Leriche syndrome, characterized by aortoiliac occlusion, presents complex surgical challenges.
• Intravenous drug abuse (IVDA) significantly increases infection risk in patients undergoing prosthetic aortic graft surgery.
• Digital gangrene indicates critical limb ischemia secondary to severe aortoiliac disease.

Observation:

• A 47-year-old male with Leriche syndrome and TASC II type-D occlusion underwent Dacron aorto-biiliac bypass.
• Postoperatively, the patient exhibited withdrawal psychosis, revealing a history of intravenous opioid abuse.
• Prosthetic graft infection is a major concern in patients with a history of IVDA.

Findings:

• The case highlights the critical need for strategies to mitigate prosthetic graft infection in IVDA patients.
• Literature review suggests endarterectomy, total endovascular repair with non-covered stents, or hybrid approaches as alternatives.
• Preserving autologous veins for potential future use in graft infection is recommended.

Implications:

• Individualized management plans are crucial, considering patient comorbidities, surgical fitness, occlusion extent, and available expertise.
• Further research is needed to establish evidence-based guidelines for managing aortoiliac occlusive disease in IVDA patients.
• This case underscores the importance of addressing patient history and risk factors in complex vascular reconstructions.