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Mycotic aneurysm. New concepts in therapy
Archives of Surgery (Chicago, Ill. : 1960)
|May 1, 1983
Summary
Mycotic aneurysms from intravenous drug abuse often lead to limb-threatening ischemia and amputation. Prompt diagnosis and surgical intervention, including revascularization, are crucial to improve outcomes for these patients.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Radiology
Background:
- Mycotic aneurysms are serious infections often linked to intravenous drug abuse.
- Delayed diagnosis is common, with initial misdiagnosis rates of 17% for conditions like cellulitis or abscess.
Purpose of the Study:
- To evaluate the outcomes of surgical treatment for mycotic aneurysms in intravenous drug users.
- To assess the impact of revascularization on limb salvage after aneurysm excision.
Main Methods:
- Retrospective analysis of 50 patients with 52 mycotic aneurysms.
- Surgical management including ligation, excision, and revascularization procedures.
- Review of diagnostic methods like arteriography and microbiological cultures.
Main Results:
- Excision of femoral artery aneurysms without revascularization led to significant morbidity (28 patients).
- Ischemia occurred in 53% of patients undergoing non-revascularized excision, with 21% requiring amputation.
- Positive cultures were found in 73% of aneurysms and 46% of patient blood samples.
Conclusions:
- Surgical excision of mycotic aneurysms can lead to severe limb ischemia and amputation, particularly in the femoral region.
- Simultaneous revascularization is critical to prevent limb-threatening ischemia after femoral artery aneurysm resection.
- Intravenous drug abuse is a significant risk factor for mycotic aneurysms, necessitating early and accurate diagnosis.