title: Bilateral mycotic axillary artery false aneurysms in an intravenous drug user: unsuspected broken needle-tips pose a risk to the treating personnel.
abstract: Mycotic false aneurysms due to local arterial injury from attempted intravenous injections in drug addicts are increasing in frequency. The high incidence of HIV and hepatitis B virus in parenteral drug users may present a considerable risk to the treating personnel. This paper reports the unsuspected presence of broken needle-tips in the subcutaneous tissues of an intravenous drug abuser, in association with bilateral mycotic aneurysms of the axillary arteries. Broken needle-tips have the potential to cause needlestick injury to the operating team and the nursing staff, with the associated risk of transmission of HIV and hepatitis B virus infection. The presence of broken needle-tips should be suspected in drug users presenting with false aneurysms associated with local arterial injection injury and a specific history of needle-breakage should be sought. Preoperative plain radiographs should be performed of the planned operative field to exclude the presence of such needle-tips. Any soft tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management.
authors.affiliation: Department of Vascular Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
authors.forename: P J
authors.initials: PJ
authors.lastname: Walker
authors.forename: G H
authors.initials: GH
authors.lastname: White
authors.forename: J P
authors.initials: JP
authors.lastname: Harris
authors.forename: K M
authors.initials: KM
authors.lastname: Alle
authors.forename: J
authors.initials: J
authors.lastname: May
mesh_terms: D000328:Adult; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000601:surgery*; D001366:Axillary Artery / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005547:Foreign Bodies / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D009339:Needles; D016602:Needlestick Injuries / Q000000981:diagnostic imaging / Q000209:etiology*; D009784:Occupational Diseases / Q000209:etiology*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D012086:Reoperation; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000000981:diagnostic imaging