Tolerable hemodynamic changes after femoral artery ligation for the treatment of infected femoral artery pseudoaneurysm.

BACKGROUND: We analyzed the hemodynamic changes induced by femoral artery ligation with concomitant thrombectomy in intravenous drug abusers with infected femoral artery pseudoaneurysm (IFAP) and their clinical significance.

METHODS: Between January 2000 and November 2007, a total of 55 patients presented to our clinic with IFAP. Among these patients, 54 were treated by femoral artery ligation with concomitant thrombectomy. Open collateral circulations were assessed by intraoperative angiography, including detection of mean artery pressure (MAP) of back-flow from the profunda femoris artery and the superficial femoral artery after operation. Patients were followed up for 3-72 months (mean 35). The data were then subjected to statistical analysis.

RESULTS: Preoperative death occurred in one patient due to acute onset of drug addiction in the ward. Preoperatively, massive necrosis developed in the left limb of the only patient with bilateral IFAPs. All 54 patients underwent femoral artery ligation with concomitant thrombectomy, including nine cases of ligation of the external iliac artery and one case of above-knee limb amputation. All wounds were completely healed within 3 months. Six late deaths (11.1%), resulting solely from refractory drug addiction, were observed during the follow-up period, of which two occurred 2 years, one 4 years, and three 5 years postoperatively. No toe amputations were noted during the follow-up period. Fourteen patients (25.9%) developed intermittent claudication. One postoperative limb was lost. Of all 54 patients, 38 were subjected to collateral circulation assessment by intraoperative angiography. Collateral circulations were found well open in a baseline path with four stations down to the distal lower limbs of all assessed patients. Four preferred types of iliac-femoral collaterals were defined. Postoperatively, compared to the external iliac artery, the MAP levels of back-flow from the profunda femoris artery and the superficial femoral artery significantly dropped to 43.89+/-2.75 and 18.08+/-2.76 mm Hg, respectively.

CONCLUSION: As a result of femoral artery ligation without reconstruction, well open collateral circulations and acceptable distal arterial runoff blood are seen, which suggests that this procedure is a reliable alternative to the emergent treatment of IFAPs in drug addicts. However, arterial reconstruction may be used as a backup approach if necessary during observation.