INJECTION DRUG USERS VASCULAR INFECTIONS
Category: Emergency Medicine
Abstract : Vascular Infections in injection drug users Vascular injury associated
with IDU includes inadvertent arterial injection with resultant vasospasm or
thrombosis, septic thrombophlebitis, venous and arterial pseudoaneurysms, and
infected hematomas. Arterial injection rarely results in major vessel occlusion;
instead, pain, edema, and patchy mottling of the affected limb caused by
ischemi
Vascular Infections in injection drug users
Vascular injury associated
with IDU includes inadvertent arterial injection with resultant vasospasm or
thrombosis, septic thrombophlebitis, venous and arterial pseudoaneurysms, and
infected hematomas. Arterial injection rarely results in major vessel occlusion;
instead, pain, edema, and patchy mottling of the affected limb caused by
ischemia occur.
Tissue necrosis and gangrene are the consequence of persistent
focal ischemia, the etiology of which is thought to be a combination of
vasospasm, embolization of particulate matter, and endothelial injury leading to
thrombosis and vasculitis.
When limb ischemia is suspected, a vascular
surgeon should determine if either surgical intervention or intraarterial
thrombolysis is indicated. However, the majority of cases involve distal
vessels, and treatment is limited to heparin and supportive care. Limb edema can
progress to compartment syndrome, which may require fasciotomy, or
rhabdomyolysis.
Infected pseudoaneurysm is a commonly reported vascular
complication in IDUs and is most often reported in the femoral, followed by the
radial and brachial arteries. Venous pseudoaneurysms are relatively rare and are
usually secondary to septic phlebitis, with the femoral vein most often
involved. Patients typically present with fever and a painful mass. Although
similar in gross appearance to an abscess, the presence of pulsations and a
bruit suggest this diagnosis.
Because of the disastrous hemorrhagic
consequences of attempted incision and drainage or medical management with a
course of antibiotics, all painful masses, particularly in the groin, should be
imaged. Treatment for infected pseudoaneurysm usually involves resection of the
infected vessel. Appropriate broad-spectrum antibiotics should be initiated in
the ED. Revascularization at the time of resection of the pseudoaneurysm may be
necessary.
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