Presentation and management of pseudoaneurysms of femoral artery.

OBJECTIVE: This study reports our experience of presentation, diagnosis and management of femoral pseudoaneurysms (PSAs).

DESIGN: Descriptive study.

PLACE AND DURATION OF STUDY: This study was carried out at South Surgical Unit, Mayo Hospital, Lahore over a 3-year period from January 2001 to December 2003.

PATIENTS AND METHODS: Data was collected noting patient's demographic characteristics, etiology of aneurysms, modes of presentation, management and outcome.

RESULTS: Thirteen patients presented with femoral artery PSAs. All except 2 were young males. Nine patients had aneurysms following IV drug abuse. Three occurred following accidental trauma and one followed angiography access. Ten presented with overt external bleeding (leaking) while 3 had closed rupture. Two PSAs were initially mistaken as an abscess and incised resulting in sudden hemorrhage. All IV drug abusers (n=9) had initial proximal / distal ligation to stop bleeding. Five had no further symptoms of ischemia, one had mild claudication, one developed rest pain and had had extra-anatomical ileo-popliteal bypass through the obturator foramen. One further patient had crossover femoral grafting because of critical ischemia. Four non-infected cases were reconstructed using direct repair, 2 reversed vein grafts and one polytetrafluoroethylene (PTFE) graft respectively. One patient (11%) each had a major and a minor limb amputation respectively. One patient left against medical advice after proximal /distal ligation. There was no mortality. There was one documented instance of recurrent drug abuse of PTFE graft.

CONCLUSION: Femoral PSAs in our study was mostly due to IV drug abuse. All PSAs were either leaking or had frankly ruptured on presentation. If significant ischemia develops on ligation, bypass through the obturator foramen, placing the graft in depth away from recurrent abuse, is a useful option. These patients also need dedicated psychiatric rehabilitation to prevent further IV drug abuse.