title: Emergency Hybrid Approach to Ruptured Femoral Pseudoaneurysm in HIV-positive Intravenous Drug Abusers.
abstract: 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.
authors.affiliation: Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy; Unità Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy. Electronic address: maurizio.domanin@unimi.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Domanin
authors.affiliation: Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Romagnoni
authors.affiliation: Unità Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Romagnoli
authors.affiliation: Unità Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Rolli
authors.affiliation: Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy; Unità Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico Milano, Milan, Italy.
authors.forename: Livio
authors.initials: L
authors.lastname: Gabrielli
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D000072226:Computed Tomography Angiography; D004630:Emergencies; D057510:Endovascular Procedures / Q000295:instrumentation; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006489:Hemostatic Techniques; D006556:Heroin Dependence / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D058850:Opiate Substitution Treatment; D015607:Stents; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014945:Wound Healing