EXTERNAL ILIAC ARTERY LIGATION AND LOCAL DEBRIDEMENT. A SAFE TREATMENT OPTION FOR INFECTED FEMORAL ARTERY PSEUDOANEURYSM IN INTRAVENOUS DRUG ABUSERS

Abstract

Introduction: “Mycotic aneurysms are defined as a localized, irreversible dilationof an artery due to destruction of the vessel wall by infection.” Intravenous (IV) drug abuse isan increasing social and health problem. Repeated punctures under septic conditions alongwith needle sharing habits among IV drug abusers result in various vascular complications.In addition, patients who present with these complications frequently have viral infections,which are hazardous to healthcare workers. Objectives: With these existing controversies ofoptimal surgical management of infected femoral artery pseudo aneurysm, we reviewed oursurgical technique used for their treatment and their clinical outcome, in a population of IVdrug abusers of Rahim Yar Khan. Study Design: Retrospective, descriptive study. Setting:Sheikh Zayed Medical College/ Hospital Rahim Yar Khan. Period: 2 years from 1-1-2015 to 31-12-2016. Material & Methods: Total 10 patients were included in this study. All patients weremanaged and operated in emergency ward. In all the patients we performed first external iliacligation and then excision of the sac and debridement of the wound. The protocol of this studyhas been approved by the ethical committee of the hospital. Results: In this 2 years study,10 patients were managed. Mean age was 22.5 years and age range from 18-28 years. Allpatients were young males and belong to low socioeconomic status. The duration of IV drugabuse was 2-3 years. A self-injection was the commonest mode of injection. All the infectedfemoral pseudo aneurysms were on the right side. 5 patients were hepatitis C virus (HCV) +veand 4 patients were hepatitis B surface antigen (HbsAg) positive. Only one patient was humanimmunodeficiency virus (HIV) positive. Five patients presented with oozing pulsating mass and5 patients with infected pulsatile mass. Right leg was survived in all the patients. There was noamputation. Conclusion: Ligation of the external iliac artery first then excision and debridementof the infected femoral artery pseudo aneurysms seems to be a safe procedure in IV drugabusers with low morbidity and no mortality. There was no amputation of the limb.