The reasons for delayed diagnosis include application of Dukes criteria for the diagnosis of RSIE, which may not be applicable, as the sensitivity and specificity of the modified Dukes criteria in RSIE has not been studied.
 In the current case series with predominantly RSIE, mortality was higher than generally reported.
There is sufficient evidence that, in uncomplicated cases of RSIE caused by Staphylococcus aureus, two weeks of antibiotic therapy is sufficient .
Very few data are present with regard to the use of the AngioVac device management of RSIE. The biggest study to date by George et al.
Our case describes a novel modality of treatment in RSIE. Although currently approved for removal of intravascular thrombi and emboli, the AngioVac device may be a promising noninvasive treatment option for RSIE for a multitude of indications.
To the best of our knowledge, these three cases are the first reported cases of RSIE secondary to intravenous nyoape use.
The valve damage in RSIE is postulated to be secondary to poor hygiene in IDU, injection of contaminated matter or abnormalities of immune function.
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