Mycotic aneurysms in parenteral drug abusers: An Indian experience

Four femoral and one brachial mycotic aneurysms were identified in five mainliners who took various narcotic injections for personal gratification. All presented with contained rupture of a pseudoaneurysm with bleed into surrounding tissues; inflammation and celluitis with loss of distal pulses; and varying degrees of ischaemia. All patients underwent emergency surgery consisting of excision of the aneurysm and debridement of the wound which was left open to granulate. Two patients had revascularisation in the same setting by an extra-anatomic bypass using a prosthetic graft. In the other three patients only ligation was performed. The state of the local tissues, degree of ischaemia and general condition of the patient governed the decision in favour of vascular reconstruction versus simple ligation. The organism most commonly identified from the arterial wall and clot culture was Staphylococcus aureus. No fungi were isolated. All patients survived without serious ischaemic complications. None needed amputation. Appreciation of this increasingly important cause of mycotic aneurysm prompts judicious decision making and surgery towards saving limb and life.