A Retrospective Review of the Management of Vascular and Soft Tissue Complications in People Who Inject Drugs at a Tertiary Vascular Surgical Unit

Introduction - In the UK hospital admissions associated with skin,soft tissue and vascular infections (SSTVI) secondary to illicit opiod use have increased in the last 5 years. People who inject drugs (PWID) utilise a significant amount of secondary care resources and the extent of this has not been fully evaluated in the contemporary literature. The utilisation of femoral vessels for injection is indicative of long-term intravenous drug use as more easily accesible vessels in the hand and antecubital fossa become thrombosed. This study evaluates the demographics, presentation, subsequent management and outcomes of PWID presenting to a tertiary vascular unit in the UK with SSVTI. The region this work was undertaken experiences the highest number of PWID related admissions to hospital in the UK. Methods - Admissions to our hospital from Jan 2014 to Dec 2017 were collected for retrospective analysis. A total of 202 patients were admitted with a SSTVI in this time period. Presenting complaint, in-patient length of stay (LOS), receiving speciality, imaging modalities, microbiology, blood borne virus (BBV) status along with subsequent medical and surgical management were reviewed. Results - 69.3% of patients admitted with a SSTVI were male with the majority being in the age range of 40-60 (55.9%). Median LOS was 6 days (IQR 2-12.75), with 49.5% of patients being treated by the Vascular Surgical team, the rest being managed across medical, orthopaedic and general surgical teams. 30.7% of patients had USS of the SSVTI, 28.7% had a CT angiogram, 10.4% had a plain x-ray and 13.9% had both CT angiogram and USS. 48% of the patients tested positive for the Hepatitis C core antigen indicating current or recent exposure to the Hepatitis C virus. 16.3% of the patients had detectable levels of Hepatitis C viraemia on ribonucleic acid. 1% of patients were positive for HIV-1. 67 patients underwent groin exploration and drainage of an abscess with 27 also requiring ligation of a femoral pseudoanueysm. No patients underwent reconstruction of the femoral artery following ligation and there were 3 above knee amputations performed during the same in-patient episode. Conclusion - We have noted a significant increase in the number of patients presenting with SSVTI over the period of our study. This has had a significant impact on resources given the LOS and multidisciplinary input required to ensure a safe and timely discharge from hospital when dealing with PWID. All patients in whom a SSVTI is suspected in the groin should undergo a CT angiogram as the imaging modality of choice as this accurately identifies any vascular complications as well as the presence of foreign bodies which may potentially cause a needle stick injury to the surgical team. Ligation of femoral pseudoaneurysms generally does not result in patients requiring amputation, however, they are often claudicants as a result.