Infected femoral artery pseudoaneurysm ligation and revascularisation: A case report.

Abstract

Although ligating femoral pseudoaneurysm is a safe procedure, some cases require revascularization, and the appropriate treatment should be tailored to the patient. In this case report, we highlight the challenge in treating infected femoral artery pseudoaneurysm. The patient, a 37-year-old male intravenous drug abuser, presented to the emergency department with a 2-month history of a progressively growing lump over his right groin. Two days before the presentation the swelling became hot and painful. After physical examination, it was revealed that the localized swelling is about 15 × 15 cm in size. It is pulsating, expanding in all directions, moving from side to side, and has been reduced in size due to proximal artery compression with the inflamed overlying skin causing slight flexion of the right hip joint and there was serosanguineous discharge as well. The affected leg was warm with intact motor and sensory function, palpable femoral, and popliteal arterial pulses, but non-palpable left posterior tibial and anterior tibial arterial pulses, both of which had triphasic wave signals on a portable hand-held Doppler (there was below knee marked edema). CT angiography (CTA) revealed a large well-defined heterogeneous cystic structure at the right groin with an average diameter of 11 × 10 × 9 cm, with a connection with the common femoral artery. After proximal and distal control, excision of the infected femoral pseudoaneurysm, a swab was taken, and ligation of the common femoral artery superficial femoral artery, and profunda femoral artery. No signals were detected on the posterior or anterior tibial arteries by hand-held Doppler and oxygen saturation on the big toe was markedly decreased, so we did an extra-anatomic lateral ilio-femoral anastomosis using silver-impregnated vascular graft.