A 45 Year Old Male Intravenous Drug Abuser with Chronic Limb Ischemia- a Challenging Case Managed Successfully

Abstract

Complications arising as from intravenous drug abuse have traditionally posed a unique challenge to vascular surgeons. Due to its easy accessibility, the femoral artery is the most commonly abused injection site for drug users. Pseudoaneurysm of the femoral artery is the most common complication among IV drug abusers who inject drugs in groin. A 45 years old male intravenous drug abuser presented to the Department of Cardiovascular Surgery of Dhaka Medical College and Hospital with rest pain and dry gangrene in his left lower limb for 6 months following surgical management of ruptured Pseudoaneurysm of femoral artery in National Institute of Cardiovascular Surgery two months back. On clinical examination he had features of chronic lower limb ischemia on left side including absent peripheral pulses, cold periphery, diminished sensation and blackening of great and 2nd toes. He also had a hypertrophic T shaped scar in his groin from previous surgery. His Doppler and CT angiography report revealed 40% narrowing of left external iliac artery with thrombotic occlusion in left common and up to mid part of superficial femoral artery with reconstituted flow in lower superficial femoral artery, popliteal, anterior and posterior tibial artery. He underwent left ilio-popliteal bypass by extraperitoneal approach. His post-operative period was uneventful with establishment of distal blood flow.