The Treatment of Infected Femoral Artery Pseudoaneurysms Secondary to Drug Abuse: 11 Years of Experience at a Single Institution.

BACKGROUND: The purpose of our study is to analyze the methods of treating infected femoral artery pseudoaneurysms (IFAPs), and also to identify the most appropriate method, especially for patients with a long history of drug abuse.

METHODS: A retrospective chart review of 88 consecutive IFAPs secondary to drug abuse between 2003 and 2014 was performed. Outpatient clinic charts were reviewed, as well as inpatient and anesthesia records. All patients had undergone a computer tomography angiography or contrast computer tomography to confirm their diagnosis. Routine blood tests were performed. The treatment methods included common femoral artery ligation (CFA) along with local debridement and drainage, direct oversewing, and amputation. A clamping test of the distal external iliac artery (EIA) or the common femoral artery was performed after vessel isolation, during which the oxygen saturation of the blood at the end of the affected limb was examined with a continuous pulse oximeter. Skin samples from affected limbs were tested with hematoxylin and eosin (HE) stain.

RESULTS: There were a total of 88 patients, of which 79 and 9 came from emergency and outpatient, respectively. Acute hemorrhage at the injection site, pulsatile mass, septic syndrome, and necrosis were present in 65, 14, 8, and 1 patients, respectively. All patients experienced groin pain. Thigh or leg swelling was present in 63 patients. The drug injection history was a mean 6.9 ± 4.1 years. Seventy-four patients presented with anemia and 75 patients presented with hypoproteinemia. Hepatitis B, hepatitis C, syphilis, and HIV were found in 42, 57, 12, and 2 patients, respectively. One patient gave up the treatment. One patient was treated by amputation along with CFA ligation and local debridement because the limb was necrotic on admission. Three patients with short drug injection abuse history and local slight infection were treated by direct oversewing. Eighty-three patients, of which 27 had a drug injection history shorter than 5 years and 56 patients longer than 5 years, were treated by CFA ligation and local debridement. All patients' oxygen saturation of the affected limbs was higher than 90% after distal EIA clamping test and ligation, except the amputation patient. None of these required amputation. One patient, whose injection history was only half a year, underwent an operation for acute ischemic performance. Forty patients had differing degrees of lymph extravasations and were treated by injecting 70% methylated amine diatrizoate. HE stain showed that there were an abundant of microcirculation vessels in IFAP patients. The mean follow-up period was mean (26 ± 14) months from 3 months to 61 months. In the group with a history shorter than 5 years, 10 patients had mild claudication in the first 3 months and then relieved from 6 months. However, in patients with a history longer than 5 years, no case presented claudication. Many of them admitted to drug abuse after surgery and rehabilitation.

CONCLUSIONS: The appropriate and tolerated treatment for most IFAP is arterial ligation, particularly in patients with an injected drug history longer than 5 years. Primary repair may be adopted for special IFAP patients with short drug injection history and limit infection to avoid severe ischemia complication. Medical staff should take strict precautions and protection measures.