Outcomes of Ligation without Revascularization in Pseudoaneurysms of Peripheral Arteries in Intravenous Drug Users

Abstract

Introduction: Management of pseudoaneurysms in intravenous drug users is complex and
challenging due to an associated infection and unavailability of autologous vein grafts. Here we
observe the outcomes of ligation and local debridement as a primary modality of treatment in this
subset of patients with pseudoaneurysms.

Methods: This is a descriptive cross sectional study of 15patients over a period of 4 years who
presented with pseudoaneurysm of peripheral artery from intravenous drug use. In this study,
we describe the presentations and management outcomes in 15 patients with peripheral arterial
pseudoaneurysmfrom IV drug use.

Results: The most common site involved was common femoral artery among 12 (80%) patients
followed by superficial femoral artery among 8 (13.3%) patients and external iliac artery in 1 (6.7%)
patient. Twelve (80%) patients were having signs of infection. All patients underwent surgical
intervention which comprised of excision of pseudoaneurysm and ligation of artery without
revascularization among 12 (80%) patients and with revascularization with autologous venous graft
among 3 (20%) patients. There was no mortality or a major bleeding requiring re-exploration. None
of the patients developed limb ischemia necessitating amputation.One patient with femoral artery
ligation without revascularization at one year of follow up is having claudication on brisk walking.
There was one saphenous vein graft thrombosis in immediate postoperative period.

Conclusions: With the use of ligation without revascularization technique, there was no mortality or
major bleeding requiring re-exploration. None of the patients developed limb ischemia necessitating
amputation so this treatment modality seems promising in treatment of pseudoaneurysms in
intravenous drug users.