title: Stent-graft placement with early debridement and antibiotic treatment for femoral pseudoaneurysms in intravenous drug addicts.
abstract: OBJECTIVE
  Explore the application of endovascular covered stent-graft (SG) placement in femoral pseudoaneurysms in intravenous drug addicts.
  
  
  METHODS
  We evaluated a consecutive series of pseudoaneurysm in intravenous drug addicts treated with SGs from August 2010 to December 2013.
  
  
  RESULTS
  15 patients with 16 arterial pseudoaneurysms were enrolled in this study. All were males with a mean age of 36.9 years. Hemorrhage was the most common reason (93.8 %) for seeking medical care, and 3 of these patients were in hemorrhagic shock at admission. All patients received broad-spectrum antibiotics, and debridement and drainage were implemented after SG placement. 7 of the 13 cases which had microbiologic results showed mixed infections, while gram-negative bacteria were the major pathogens. Except for 2 patients, who were lost to follow-up, two new pseudoaneurysms formed due to delayed debridement, and one stent thrombosis occurred, none of the remaining cases had SG infection or developed claudication.
  
  
  CONCLUSIONS
  SG placement controls massive hemorrhage rapidly, gives enough time for subsequent treatment for pseudoaneurysms due to intravenous drug abuse, and reduces the incidence of postoperative claudication. With appropriate broad-spectrum antibiotics and early debridement, the incidence of SG infection is relatively low. It is an effective alternative especially as temporary bridge measure for critical patients. However, the high cost, uncertain long-term prospects, high demand for medical adherence, and the risk of using the conduits for re-puncture call for a cautious selection of patients. More evidence is required for the application of this treatment.
authors.affiliation: Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Street, Yuzhong District, Chongqing, 400016, China, cqmufqn@163.com.
authors.forename: Qining
authors.initials: Q
authors.lastname: Fu
authors.forename: Xiyun
authors.initials: X
authors.lastname: Meng
authors.forename: Fenghe
authors.initials: F
authors.lastname: Li
authors.forename: Xuehu
authors.initials: X
authors.lastname: Wang
authors.forename: Jun
authors.initials: J
authors.lastname: Cheng
authors.forename: Wen
authors.initials: W
authors.lastname: Huang
authors.forename: Wei
authors.initials: W
authors.lastname: Ren
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhao
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D003646:Debridement; D055030:Drug Users; D005263:Femoral Artery / Q000601:surgery*; D006470:Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D015819:Substance Abuse, Intravenous / Q000150:complications*; D016896:Treatment Outcome