G. S. Georgiadis MD; M. K. Lazarides MD, A. Polychronidis MD, C. Simopoulos MD.
Surgical treatment of femoral artery infected false aneurysms in drug abusers
Article first published online: 11 NOV 2005
ANZ Journal of Surgery
Volume 75, Issue 11, pages 1005–1010, November 2005
How to Cite
Georgiadis, G. S., Lazarides, M. K., Polychronidis, A. and Simopoulos, C. (2005), Surgical treatment of femoral artery infected false aneurysms in drug abusers. ANZ Journal of Surgery, 75: 1005–1010. doi: 10.1111/j.1445-2197.2005.03578.x
- Issue published online: 11 NOV 2005
- Article first published online: 11 NOV 2005
- Accepted for publication 19 June 2005.
- drug abusers;
- infected false aneurysms
Background: Post-traumatic femoral artery infected false aneurysms (pfa-IFA) in drug abusers are very common in modern societies, but their surgical management remains controversial.
Methods: A review was undertaken of the English-language literature between 1967 and 2004 for relevant articles describing at least four cases of pfa-IFA in drug-addict populations. The available surgical treatment options are discussed.
Results: Recent surgical therapeutic reports favour aneurysm ligation and excision (Lig-Exc) and local debridement (Ld) with observation-selective (delayed) revascularization in cases where limb viability is threatened, or Lig-Exc and Ld alone without vascular reconstruction. The former method carries the risk of delayed decision on attempted extremity salvage (12.1% amputation rate), accepting early (13.5%) and late (7.5%) claudication rate, and although the latter method has much lower early and late amputation rates (5.7 and 6.3%, respectively), it results in a high percentage of claudication and disability (early, 54.4%; late, 44.3%). Immediate (routine) revascularization using either in situ or extra-anatomic bypass has also been associated with high complication rates. Even when it occurs through non-infected tissue planes, the risk of graft infection (early, 21.1%; late, 32.4%) is of great concern, and the possibility of sepsis (together with anastomotic dehiscence (14%) and even amputation) is high (early, 9.8%; late, 11.3%). Reversing the order of revascularization produces zero early complication rates, but long-term follow up reveals that 5.5% of patients have graft infection and 5.5% have had amputation. The follow up rates reported in the literature are poor (only 31.7% completed), and are also sometimes inaccurate.
Conclusions: No surgical treatment for pfa-IFA has been proved to be safe in terms of the overall surgical complications. Longer follow-up periods are needed to provide accurate results.