fig.1(post.op.angiogram)
fig.2(graphic representation of the procedure done)
The menace of drug addiction seems to be ever increasing with all efforts to curb it by educating the youth seemingly unfruitful.Mushrooming de-addiction centres all around stand testimony to this and there seems to be no way out as of now.Unfortunately the drug addicts are increasingly getting hooked to injectables which is scary.The superficial veins get thrombosed with repeated punctures and then starts this cycle of “SELF MUTILATION”wherein the addict repeatedly punctures his otherwise accessible arteries to push that drug in.These guys invariably land up in the emergency department with profuse uncontrollable bleeding from the puncture site.
MYCOTIC aneurysms is a common phenomenon reported in drug abusers especially in this part of India where drug abuse is widely prevalent.We report to you a similar case of drug abuse in a 32 years old male who came to us with profuse bleeding from his right groin.The wound site was tightly bandaged so as to stop bleeding by the practitioner at the periphery so as the patient can make it in time to our centre . General physical examination revealed the patient running down with high grade fever for the last 3 days with chills.
The usual surgical treatment option in a case like this is doing a traditional obturator foramen bypass followed by wide debridement of the infected site with proximal and distal ligation of the femoral vessels.Obturator foramen bypass is too taxing a surgery for the patient and probably the operating surgeon as well for it involves alot of tissue dissection and the probability of localized infection getting disseminated to the fresh surgical site is always there for the inflow site is ipsilateral to site of infection.
Infrascrotal perineal femoro-femoral bypass is a far better option in cases with unilateral groin infection.Though it needs expertise but its worth the effort with far less maceration to the tissues as there is not need to open the abdomen/peritoneum. There are no trials till date comparing these two procedures but the reports coming in from different vascular surgical centres doing the bypass with infrascrotal approach are encouraging as they suggest a significantly better primary patency rate of the graft as compared to the obturator approach.There are only few cases done with the infrascrotal approach till date.Not sure if this has been attempted before in India as not much data is available from India..Would love to know the experiences of my colleagues back in India .
Anyways we did this case with 8mm PTFE graft without much of hassles and our patient is doing fine. I have done a couple of cases with the obturator foramen approach when I was in Hyderabad but found this newly acquired approach a better option as of now.
