Studying the results of femoral artery ligation in 65 patients with infected pseudoaneurysm due to IV-drug abuse

ABSTRACT

Regarding the increasing numbers of IV drug addicts, the incidence of infected pseudoaneurysm is increasing. So far, different therapeutic strategies have been tried, but each method has its own drawbacks. Therefore, discovering an appropriate thera-peutic method is necessary. 65 patients with infected pseudoaneurysm due to drug injection referred to Shohada Medical Center from Feb 1994 till Oct 2003 were chosen. After obtaining proximal control of the external iliac artery, femoral artery ligation was performed in all patients. The patients were observed for signs and symptoms of ischemia.After primary ligation of the involved artery, acute ischemia occurred in only 6 patients who later underwent extra-anatomical bypass. Only 3 patients underwent amputation. One of them was performed after extra-anatomical bypass and two cases after arterial ligation, as ischemia and gangrene had been present on admission. During patient follow up [minimum 3 months, maximum 3 years and average 12 months], 8 cases of slight claudication [9.3%] and 3 cases of severe claudication were reported and the rest have been symptom-free.Various treatments have been used for infected pseudoaneurysm, but none of them are faultless. According to infection of the site and existence of extensive necrosis and inflammatory tissue, anatomical and even non-anatomical bypasses are almost im-probable. The results of this study indicate that arterial ligation could be the first and probably the best choice of treatment in such patients with less cost and also without mentionable morbidity or mortality. This procedure must be performed in a vascular surgery center to perform vascular bypass if needed