Background: Chronic traumatism of the common femoral artery due to intravenous injection in drug abusers, in association with local infections and arterial wall weakening caused by human immunodeficiency virus (HIV), can lead to the development of pseudoaneurysms (PSAs). Rupture of PSA is a dramatic event in such patients, and its correction is difficult and controversial.Most of the cases reported describe open surgical elective options, which consist in ligation, repair, or substitution of the damaged arterial segment, using when possible biological grafts. In literature, few cases describe an endovascular repair with covered stent deployment. Methods: We present 2 cases of HIV-positive intravenous injection in drug abusers who needed emergency treatment for active bleeding in ruptured PSA of the right common femoral artery. In both cases, under general anesthesia needed for lack of patient's compliance and unstable hemodynamics, a short dissection to the distal superficial femoral artery was required. Results: Then, maintaining a manual compression on the bleeding site to stop hemorrhage, we deployed a covered stent graft in the site of the arterial breakdown through a retrograde approach. Conclusions: The favorable results and progressive healing of wound and local infections persuaded us not to perform any further surgical correction. The absence of recurrences and late complications, after 3 years in the first case and 1 year in the second one, lead us to consider this hybrid endovascular approach as a valuable alternative to open surgery in HIV intravenous injection in drug abuser patients, in particularly when emergency conditions occur.
Emergency Hybrid Approach to Ruptured Femoral Pseudoaneurysm in HIV-positive Intravenous Drug Abusers / M. Domanin, G. Romagnoni, S. Romagnoli, A. Rolli, L. Gabrielli. - In: ANNALS OF VASCULAR SURGERY. - ISSN 0890-5096. - 40(2017 Apr 20), pp. 297.e5-297.e12.
|Titolo:||Emergency Hybrid Approach to Ruptured Femoral Pseudoaneurysm in HIV-positive Intravenous Drug Abusers|
DOMANIN, MAURIZIO (Primo)
GABRIELLI, LIVIO (Ultimo)
|Parole Chiave:||surgery; cardiology and cardiovascular medicine|
|Settore Scientifico Disciplinare:||Settore MED/22 - Chirurgia Vascolare|
|Data di pubblicazione:||20-apr-2017|
|Data ahead of print / Data di stampa:||2016|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1016/j.avsg.2016.07.086|
|Appare nelle tipologie:||01 - Articolo su periodico|