Complications after intravenous drug abuse and the diagnostic value of color flow duplex scanning

The complications of intravenous drug abuse (IVDA) require accurate diagnosis in order to select appropriate treatment. This has involved invasive imaging techniques, but more recently duplex scanning has been used as the primary investigation in the management of these patients. Fifty- seven limbs of 47 consecutive outpatient intravenous drug abusers (24 male, 23 female, mean age 32 years, range 19-51 years) who presented with pain, with or without swelling, following IVDA were examined with color flow duplex imaging. Deep venous thrombosis (DVT) was diagnosed in 37 (63%) limbs (22 iliofemoral, 5 femoral, 10 femoropopliteal). Ten patients had bilateral DVT and in seven the DVT was recurrent (26%). One patient had axillary vein thrombosis. Three patients (11%) developed symptomatic nonfatal pulmonary emboli. Of the 19 limbs (33%) without DVT, 2 had superficial vein thrombosis of the upper limb, 1 a groin abscess, 1 a groin hematoma, 1 pseudoaneurysm of the common femoral artery, 1 extensive cellulitis, 2 arteriovenous fistulae, and 2 distal ischemia from intra-arterial injection. In nine limbs no pathology was detected. The most common complication in symptomatic IVDA is a DVT in the proximal veins of the lower limb. Other pathologies are also seen. The location and extent of DVT is easily detected by ultrasound. It also allows accurate diagnosis of the other pathologies, and thus appropriate treatment can be applied without the need for invasive angiographic techniques.