Ruptured infected femoral pseudoaneurysm in iv drug abusers ligation under local anesthesia

Background: IV drug abusers usually present with life threatening hemorrhage from ruptured infected femoral pseudoaneurysm in emergency. Back up of family, friends and resources are marginal with these patients. In literature many procedures from simple debridement to extra anatomic bypass have been reported

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Objective: To assess the outcome of ligation of external iliac artery under local anesthesia in terms of survival, limb salvage and feasibility

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Methodology: This cross sectional study was conducted in Department of Surgery, Quaid e Azam Medical College, Bahawalpur. Duration of study was five years from 1st December 2010 to 31st December 2015. All patients presenting with bleeding or ruptured femoral pseudoaneurysm in this time span were admitted. Pressure dressing over bleeding aneurysm was done; wide bore peripheral IV line/CV line was passed; fluid resuscitation was started; broad spectrum antibiotics were injected; request for blood arrangement sent and necessary investigations were sent; special consent was taken. Local Anesthesia was injected in the groin just above the aneurysm ketamine given their needed. External iliac artery was explored in supra inguinal position and ligated. Data regarding age, gender, drug of abuse, vascular status of the limb, need for blood transfusion during procedure, life safety, limb salvage was analyzed. Data was entered and analyzed by using SPSS version 20

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Results: We ligated external iliac artery just proximal to aneurysm in 48 patients under local anesthesia. Life and limb was saved in 43 [89.5%] patients. Five patients [10.5%] required above knee amputation later

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Conclusion: Ligation of external iliac artery under local anesthesia in ruptured pseudo aneurysms is simple and safe