OPTIMAL PRIMARY SURGICAL MANAGEMENT OF INFECTED PSEUDOANEURYSM IN INTRAVENOUS DRUG ABUSERS: LIGATION OR RECONSTRUCTION?

Primary Surgical Management of Infected Pseudoaneurysm

Abstract

Objective: To find out the optimal primary surgical treatment options for infected pseudoaneurysm in
intravenous drug abusers.
Study Design: Cross sectional descriptive study.
Place and Duration of Study: Department of Vascular Surgery, Combined Military Hospital Lahore, from Jan 2010 to Jun 2015.
Material and Methods: A total of 31 consecutive patients with a history of intravenous drug abuse and an
infected pseudoaneurysm in the groin or elbow, presenting in emergency department; were included in this
study. All patients were primarily treated with ligation of the artery, excision of infected pseudoaneurysm and
debridement of necrotic tissues. Only one patient underwent additional revascularization procedure.
Results: All patients who underwent ligation and excision procedures did well initially. One (3.2%) patient
developed severe distal ischemia after ligation of femoral artery within first 24 hours, so extra anatomic
revascularization procedure was performed. Five (16.1%) patients required revascularization procedure after 16 weeks due to disabling distal ischemia. No amputation was needed and mortality rate was zero.
Conclusion: Primary ligation of the artery with excision of infected pseudoaneurysm and necrotic material was found the optimal initial management for infected pseudoaneurysm in intravenous drug addicts. Ischemic complications if develop should be treated with early or late revascularization.