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Ruptured mycotic aneurysm: a complication of parenteral drug abuse
Abstract:
Mycotic aneurysms occurred in five narcotics addicts treated between 1969 and 1975. Fever, localized tenderness, swelling, loss of distal pulses, and leukocytosis were common findings. The aneurysms were located in the femoral (two patients), brachial (two), and superior mesenteric arteries (one). They occurred at the site of arterial injection in three patients. In one patient with subacute bacterial endocarditis, an aneurysm of the superior mesenteric artery developed. In one patient, the pathogenesis was uncertain. All patients had rupture of the arterial wall, with hemorrhage contained by adjacent muscle or soft tissue. Four patients were treated by ligation and debridement. One, with preexisting ischemia, required amputation below the knee. One patient underwent repair with autogenous artery. Recurrent hemorrhage necessitated ligation of the artery. In all patients, extensive sepsis and tissue necrosis precluded repair with prosthetic material. All patients survived, without evident of ischemia.
Insights
This study reports on five cases of mycotic aneurysms in narcotics addicts, highlighting common symptoms and arterial locations. Surgical management, including ligation and debridement, proved effective for these serious infections.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Medical Case Studies
Background:
- Mycotic aneurysms are rare but serious arterial infections.
- Intravenous drug abuse is an identified risk factor for mycotic aneurysms.
- Early diagnosis and appropriate management are crucial for patient outcomes.
Observation:
- Five cases of mycotic aneurysms in narcotics addicts were observed between 1969 and 1975.
- Common clinical presentations included fever, localized tenderness, swelling, diminished pulses, and leukocytosis.
- Aneurysms were located in the femoral, brachial, and superior mesenteric arteries, often at injection sites.
Findings:
- All patients presented with arterial wall rupture and contained hemorrhage.
- Surgical intervention, primarily ligation and debridement, was the mainstay of treatment.
- Prosthetic material repair was precluded by extensive sepsis and tissue necrosis.
Implications:
- Mycotic aneurysms in intravenous drug users require prompt surgical intervention.
- Ligation and debridement are effective treatments when prosthetic repair is not feasible.
- Aggressive management can lead to successful outcomes, even in complex cases.