Mycotic aneurysms in parenteral drug abusers: An Indian experience

  • Uttam Tripathy
  • S. K. Khanna
Original Article


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.


Drug Addict Mycotic Aneurysm Infected Aneurysm Left Common Iliac Artery Parenteral Drug Abuse 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Reddy DJ, Ernst CB. Infected aneurysms.In Rutherford RB, ed.Vascular Surgery, 3rd edition; Philadelphia WB Saunders Company, 1989: 983–96.Google Scholar
  2. 2.
    Osier W. The Gulstonian lectures on malingnant endocarditis.Br Med J 1885;1: 467–70.CrossRefGoogle Scholar
  3. 3.
    Revel STR Jr. Primary mycotic aneurysms.Ann Intern Med 1945;22: 431–40.Google Scholar
  4. 4.
    Stengel A, Wolferth CC. Mycotic (bacterial) aneurysms of intravascular origin.Arch Intern Med 1923;31:527–54.Google Scholar
  5. 5.
    Yellin AE. Ruptured mycotic aneurysm —a complication of parenteral drug abuse.Arch Surg 1977;112: 981–6.PubMedGoogle Scholar
  6. 6.
    Mokoena T, Robbs JV. Surgical management mycotic aneurysms.South Afr J Surg 1991;29: 103–7.Google Scholar
  7. 7.
    Fromm SH, Lucas CE. Obturator bypass for mycotic aneurysm in the drug addict.Arch Surg 1970;100: 82–3.PubMedGoogle Scholar
  8. 8.
    Huebl H, Read RC. Aneurysmal abscess.Minn Med 1966;49: 11–6.PubMedGoogle Scholar
  9. 9.
    Hankins JR, Yeager GH. Primary mycotic aneurysm.Surgery 1956;40: 477–546.Google Scholar
  10. 10.
    O’Conner TW, Lord RA, Tracy GD. Treatment of mycotic aneurysms.Med J Aust 1972;2: 1161–4.Google Scholar
  11. 11.
    Anderson CB, Butcher HR Jr, Ballinger WF. Mycotic aneurysms.Arch Surg 1974;109: 712–7.PubMedGoogle Scholar
  12. 12.
    Feldmen J, Berguer R. Management of an infected aneurysm of the groin secondary to drug abuse.Surg Gynecol Obstet 1983;157: 519–22.Google Scholar
  13. 13.
    Mundith ED, Darling RC, Alvarado RH,et al. Surgical management of mycotic aneurysms and the complications of infection in vascular reconstructive surgery.Am J Surg 1969;117: 460–70.CrossRefGoogle Scholar
  14. 14.
    Smith RF, Szilagyi DE, Colville JM. Surgical management mycotic aneurysms.Arch Surg 1962;85: 663–75.PubMedGoogle Scholar
  15. 15.
    Patel S, Johnston KW. Classification and management of mycotic aneurysms.Surg Gynecol Obstet 1977;144: 691–4.PubMedGoogle Scholar
  16. 16.
    Moore HD, Telling M. Resection of the aortic bifurcation for relief of a mycotic aneurysm of the left common iliac artery, and its replacement by preserved arterial graft.Br J Surg 1954;42: 420–6.CrossRefGoogle Scholar
  17. 17.
    Leather RP, Karmody AM. A lateral route for extraanatomic bypass of the femoral artery.Surgery 1977;81: 307–9.PubMedGoogle Scholar
  18. 18.
    Reddy DJ, Smith RF, Elliot JP Jr,et al. Infected femoral artery false aneurysms in drug addicts. Evolution of selective vascular reconstruction.J Vasc Surg 1986;3: 718–24.PubMedCrossRefGoogle Scholar

Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 1994

Authors and Affiliations

  • Uttam Tripathy
    • 1
  • S. K. Khanna
    • 1
  1. 1.Department of General Surgery (Vascular Surgery Unit)Postgraduate Institute of Medical Education and ResearchChandigarhIndia

Personalised recommendations