Incidence and outcomes of infected peripheral pseudoaneurysms in drug abusers

Abstract

BACKGROUND: Intravenous drug abusers (IVDA) are at an increased risk of developing infected peripheral pseudoaneurysms. The aim of this study is to describe a group of IVDA patients who present with infected peripheral pseudoaneurysms and to evaluate the outcomes of vascular surgery reconstruction in this population. MATERIALS AND METHODS: A retrospective study of all IVDA patients presenting with peripheral pseudoaneurysms between 2009 and 2015 in the premier healthcare vascular surgery database 2009–2015 were identified. Patients' demographics, comorbidities, along with the vascular procedures performed, and in-hospital complications were reported. RESULTS: Out of 2012 vascular surgery patients known to be opioid abusers, 71 (3.5%) presented with infected peripheral pseudoaneurysms (mean age: 44.8 years, standard deviation: 15.0). The majority of these patients were Caucasians or Whites (64.8%) and underwent resection of the upper or lower limb arteries (29.7%), clipping of aneurysm (21.9%), or bypass procedures (9.4%). Two patients (3.1%) underwent primary major amputation. In-hospital mortality was observed in 1.4% of patients, hemorrhage/shock in 12.7% and cardiac arrhythmias in 7%. Four patients (5.6%) underwent secondary major amputation during the same hospitalization. Median length of hospital stay was 8 days. Around 24% of these patients were discharged to a skilled nursing facility or a rehabilitation center. The median cost of hospitalization for these patients was 21,807 (USD) with a median fixed and variable cost of 10,392 and 9356 (USD), respectively. CONCLUSION: IVDA patients with infected pseudoaneurysms are at high risk for postoperative complications, major morbidity, extended length of stay, and nonhome discharge destination which poses a huge medical, social, and economic burden.

Keywords

• drug abuse
• infected pseudoaneurysms
• outcomes
• vascular surgery