Duplex Ultrasound Findings in Intravenous Drug Users with Femoral Vein Injection

Abstract

Introduction

—Intravenous drug users (IVDUs) who access their common femoral vein (CFV) repetitively are at risk for a variety of vascular complications. Duplex ultrasound is often the initial imaging modality used when these patients present for medical care. The purpose of this study was to document the duplex ultrasound findings and associated clinical outcomes in IVDU with CFV injection.

Methods

—This was an institutional review board-approved retrospective review of all lower-extremity duplex ultrasound examinations performed on IVDU in our laboratory from January 1, 2007 through December 31, 2009. Vascular laboratory reports and images were reviewed along with clinic and hospital records.

Results

—The study cohort included 29 patients, 52 lower limbs, and 102 duplex ultrasound examinations. There were 16 males and 13 females with an age range of 19 to 53 years (mean, 33 years). Follow-up intervals ranged from 0 to 24 months (mean, 11 months). The most common indication for duplex ultrasound was a swollen painful leg. Abnormalities were present on duplex ultrasound in 92% of the limbs. A CFV stricture was identified in 63% of the limbs and 44% had cystic masses associated with the proximal femoral vessels. Progression to DVT was observed in 45% of the CFV strictures. Arterial lesions were found in 21% of the limbs. One retained needle was identified. Venous or arterial interventions were required in 9 limbs.

Conclusion

—Femoral injection in IVDU results in a high prevalence of abnormal vascular findings on duplex ultrasound. Although venous lesions were more common, arterial and venous interventions were approximately equal in frequency. The IVDU patients also had a high prevalence of lower-limb DVT. The vascular laboratory can play an important role in the evaluation of IVDU with CFV injection. This review suggests that duplex ultrasound in these patients should include both a complete lower extremity venous examination and assessment of the iliac and femoral arteries.