Salman Yousuf Guraya, Kamran Khalid, Javed Raza Gardezi, Ahsan Nasim, Ghulam Akbar Sial.
Ruptured Traumatic Pseudoaneurysm of Right Femoral Artery in a Mainline Drug Abuser.
J Coll Physicians Surg Pak Jan ;10(8):312-3.

Serious complications of intravascular drug abuse are being encountered with increasing frequency. The gravity of this scenario stems from the fact that a wide range of drugs are being self administered and the medical advice is sought after the emergence of one of the dreadful complications of intravascular drug abuse. We report a case of 40 years old male, known mainline drug abuser, presenting in our Accident and Emergency Department, with 24 hours history of intermittent bleeding from a painful, ulcerated lump in right groin leading to sudden massive hemorrhage necessitating packing and referral to our emergency from a district hospital. A clinical diagnosis of ruptured infected pseudoaneurysm of right femoral artery was made and urgent exploration was undertaken after initial resuscitation. Excision followed by interposition saphenous vein graft between common femoral and superficial femoral artery with ligation of deep femoral artery lead to uneventful recovery and limb salvage. While managing such complications in drug abusers, the patients as a whole, must be taken into consideration because the vascular component is one of the multiple facets of their treatment that needs to be addressed.

CASE REPORT: A 40 years old male presented with bleeding from a mass in right groin for one day. Patient was a known drug abuser who had been injecting different drugs in his radial and brachial arteries for the last fifteen years. He used to inject his right femoral artery far drug abuse for the last six months. A month ago he noticed a lump in the groin which gradually got bigger. Later on, an ulcer developed on the surface of the lump which broke down on the day of presentation resulting in torrential hemorrhage. He had continuous low grade fever for the last fifteen days and had an episode of jaundice six months back which settled with conservative treatment. Systemic examination was unremarkable apart from multiple puncture marks all over the body, more so on the limbs. He was in shock at the time of admission and the distal pulses were not palpable in right lower limb. Patient had a huge pulsatile mass in the groin. After initial resuscitation, tetanus prophylaxis, b spectrum antibiotics, blood transfusion arrangements, an urgent exploration was undertaken. Precautions included information to anesthetist and paramedics, use of double gloves, cautery and minimal use of sharp objects. Proximal control was obtained and main mass was opened which revealed enormous amount of necrotic tissue along with grossly infected groin nodes. About 6 cm length of common femoral artery and the commencement of superficial femoral artery were non-existent. Thorough wound debridement was carried out by reverse saphenous vein interposition and ligation of profunda femoris. Culture of pus from the wound grew mixed flora of E coli and Staph aureus sensitive to ciprofloxacin which was given for ten days. Patient was diagnosed to be HIV positive. He made an uneventful recovery and was discharged on postoperative day with a view to have planned psychiatric rehabilitation.

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