Surgical treatment of femoral artery infected false aneurysms in drug abusers

Abstract

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.