Mohammad Ali Iqbal, Muhammad Shahzeb Najam, Muhammad Najmuddin Shabbir, Jai Kershan.
Outcomes after external iliac artery ligation in infected pseudo aneurysms of femoral artery in I/V drug abusers: role of collateral circulation.
Pak J Surg Jan ;35(1):12-5.

Objectives: To determine the optimal management of infected pseudoaneurysms of femoral artery in I/V drug abusing patients. Material and Methods: This retrospective study was conducted at SU-IV, Civil Hospital, Faisalabad Medical University, Faisalabad. Inpatient records of 52 patients with history of I/V drug abuse presenting with infected pseudo aneurysms of femoral artery were analysed over a 5 years period from 01 January 2011 to 31 December 2016. Only those cases were included in the study where emergency ligation of external iliac artery along with excision of pseudo aneurysm and debridement of necrotic tissue was performed. Surgical approach was through a suprainguinal incision approaching external iliac artery retroperitoneally. Data was recorded on demographic, clinical, management and outcome parameters. Results: 52 patients presenting with infected pseudoaneurysms of femoral artery due to I/V drug abuse were included in the study with a mean age of 33 years (19-47). All had pseudoaneurysms in the common femoral artery proximal to its bifurcation. 26 in the mid common femoral artery, 19 in the distal third and 7 in the upper third below the inferior border of inguinal ligament. Post-operatively there was no haemorrhage, vascular thrombosis, amputations, or mortality in the series and limb salvage was 100 percent.17 patients developed claudication in the 6 months followup period and were managed conservatively. Mean duration of abuse was 5 years. Conclusion: We concluded that ligation of external iliac artery is a safe and effective procedure in the management of infected pseudoaneurysms of femoral artery in relatively younger group of I/V drug abuser patients. It avoids intervention in infected tissues planes and subsequent complications with remarkable limb salvage as shown in our study. Revascularisation can be performed in patients developing disabling claudication.

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