When Vascular Meets Surgical

Author: Arunkumar Sethuraman, Saboora Nasir / Editor: Sarah Edwards / Codes: DC5, MHC1, SLO1, VC3 / Published: 27/08/2025

A 35-year-old male presents to the Emergency Department (ED) in a wheelchair due to significant pain and swelling in his left leg following a 14-hour flight. He has a history of intravenous heroin use.

He reports injecting heroin into his left groin several weeks earlier, leading to common femoral vein (CFV) injury and acute venous thrombosis. He underwent CFV repair and debridement of an injected haematoma in Thailand and was discharged on oral antibiotics and analgesia.

On arrival, his vital signs are as follows: pulse 108/min, blood pressure 103/56 mmHg, temperature 37.2°C, respiratory rate 22/min, and SpO2 95% on room air. Cardiovascular, respiratory, and other systemic examinations are unremarkable.

His left leg is swollen but warm and well-perfused, with intact pulses and no features of acute limb ischaemia. A groin surgical wound is visible, and gauze packing is noted in a separate wound on the left calf.

A junior doctor suspects a deep vein thrombosis (DVT) and arranges a venous Doppler ultrasound, which confirms acute thrombosis in the CFV and superficial femoral vein. A senior clinician later reviews the case and notes slough and non-granulating tissue at the groin wound, raising suspicion of a deep soft tissue abscess. Similar slough is found in the calf wound after removal of the gauze.

Vascular surgery is consulted but decline admission, citing preserved perfusion. A plain CT scan of the operative site and limb is performed, revealing a large lobulated soft tissue mass in the groin, consistent with a phlegmonous abscess or infected haematoma.

The patient is referred to the general surgery team for further management.

Bloods: CRP 60.7, WBC 11.4, Hb 92, PLT 852, D-dimer 6016.