Institute of Forensic Medicine, University of Belgrade - School of Medicine, Belgrade, Serbia.
J Forensic Sci. 2022 Sep;67(5):1915-1923. doi: 10.1111/1556-4029.15081. Epub 2022 Jun 14.
Intravenous drug users (IDUs) eventually encounter a common problem- a need to turn to a new vessel to inject drugs. Whether it is because no other spot is available due to scarring or convenience, the groin is the preferred spot for some. Chronic puncture of femoral vessels can lead to a rare but significant complication- femoral artery pseudoaneurysm (FAP). Its fatal consequence- rupture and bleeding is well recognized, but the forensic literature on this subject is limited. We present eight cases of exsanguination due to the ruptured FAP in IDUs who share most or all the following characteristics: long-term heroin use and/or pronounced drug use stigmata, chronic groin injection-related lesions, absence of significant precipitating pseudoaneurysm trauma, and no or minimal concentrations of heroin metabolites in blood. The FAP presentation varied greatly, from palpable fist-sized mass or slight elevation under the skin defect to infundibular arterio-cutaneous fistula that ruptured through the skin induration. In some, surrounding skin or soft tissue showed signs of inflammation but without suppuration. The most prominent FAP characteristic was smooth-surface cavitation on cross-sections. We performed microscopic evaluation in two cases and verified disruption of the artery wall (i.e., pseudoaneurysm) with elements of acute and chronic inflammation and fibrosis; foci of fibrinoid necrosis were noticed on the arterial wall. All subjects were pale, with faint hypostasis and organ anemia, consistent with reported massive hemorrhage. Because such sudden, unwitnessed, and suspicious deaths may raise the question of injury infliction, proper autopsy evaluation is crucial, for which we propose guidelines.
静脉注射吸毒者（IDU）最终会遇到一个共同的问题——需要转向新的血管注射毒品。无论是由于疤痕或便利性而导致其他部位无法使用，还是因为一些人更喜欢在腹股沟部位注射，这种情况都很常见。股血管的慢性穿刺可能导致一种罕见但严重的并发症——股动脉假性动脉瘤（FAP）。其致命后果——破裂和出血是众所周知的，但关于这个主题的法医学文献有限。我们报告了 8 例因破裂的 FAP 导致 IDU 失血过多而死亡的病例，这些病例具有以下共同特征：长期使用海洛因和/或明显的药物使用痕迹、慢性腹股沟注射相关病变、没有明显的导致假性动脉瘤的创伤，以及血液中无或极少浓度的海洛因代谢物。FAP 的表现差异很大，从可触及的拳头大小的肿块或皮肤缺陷下的轻微隆起，到通过皮肤硬结破裂的漏斗状动静脉瘘。在某些情况下，周围的皮肤或软组织有炎症迹象，但没有化脓。最突出的 FAP 特征是在横截面上具有光滑表面的空洞。我们在 2 例中进行了显微镜评估，并证实了动脉壁的破裂（即假性动脉瘤），伴有急性和慢性炎症和纤维化的元素；在动脉壁上注意到纤维蛋白样坏死的病灶。所有的尸检对象都面色苍白，有轻微的皮下淤血和器官贫血，与报道的大量出血一致。由于这种突然、无人目睹和可疑的死亡可能引发伤害的质疑，因此适当的尸检评估至关重要，为此我们提出了一些指导原则。
