Journal Article

Management of the infected arterial pseudoaneurysm secondary to groin injecting drug use and outcomes: a systematic review protocol

Nagy, John, Suttie, Stuart, Radley, Andrew, Khan, Faisel, MacLeod, Caitlin Sara, Strachan, David

2023

Overview

IntroductionPeople who inject drugs are at risk of a range of injecting-related infections and injuries, which can threaten life and limb. In parallel to escalating rates of drug-related deaths seen in Scotland and the UK, there has also been an increase in hospital admissions for skin and soft tissue infections related to injecting drug use. One such injecting complication is the infected arterial pseudoaneurysm, which risks rupture and life-threatening haemorrhage. Surgical management options for the infected arterial pseudoaneurysm secondary to groin injecting drug use remain contentious, with some advocates for ligation and debridement alone, whilst others promote acute arterial reconstruction (suture or patch repair, bypass or, more recently, endovascular stent-graft placement). Rates of major lower limb amputations related to surgical management for this pathology vary in the literature. This review aims to evaluate the outcomes of arterial ligation alone compared with arterial reconstruction, including open and endovascular options, for the infected arterial pseudoaneurysm secondary to groin injecting drug use.Methods and analysisThe methods will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Three electronic databases will be searched and the resultant papers screened according to the study inclusion and exclusion criteria (detailed in the Population, Intervention, Comparison, Outcomes and Study design statement). Grey literature will be excluded. All papers at each stage will be screened by two independent authors, with disagreements arbitrated by a third. Papers will be subject to appropriate standardised quality assessments.Primary outcomeMajor lower limb amputation.Secondary outcomesReintervention rate, rebleeding rate, development of chronic limb-threatening ischaemia 30-day mortality and claudication.Ethics and disseminationThis is a systematic review based on previously conducted studies, therefore, no ethical approval is required. The results of this work will be published in a peer-reviewed journal and presented at relevant conferences.PROSPERO registration numberCRD42022358209.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Amputation / Debridement / Drug use / Hemorrhage / Infections / Intervention / Ischemia / Mortality / Prostheses / Pseudoaneurysm / PUBLIC HEALTH / Substance misuse / Surgery / Surgical pathology / Systematic review / Vascular surgery / Veins & arteries