Management of Intravenous Drug Abusers Groin Pseudoaneurysms: Ligation or Reconstruction? (Systematic Review)

Abstract

Introduction: Infected femoral pseudo aneurysms are the most common type of infected aneurysm observed in clinical practice, largely explained by increase intravenous drug abuser (IVDU) in the recent years. Management of such a condition remains controversial due to high rate of amputation and disabled claudication after surgical management. The Aim of the review is to critically evaluate different surgical management options of intravenous drug abuser groin pseudoaneurysms. Methods: A systematic review of published literature with regard to the arterial consequences of intravenous drug abuser groin pseudoaneurysms' surgical management options was undertaken using the PUBMED, EMBASE, and Medline databases from January 1980 to January 2019. Search was performed using combination of keywords : ''intravenous drug abuse'', ''pseudo-aneurysm'', ''limb ischaemia'' , ''intra-arterial injection'', "artery ligation" and "bypass surgery". Results: A total of 21 articles were identified covering a total of 529 patients. Selected articles were case reports (n = 5), case series (n = 6) or retrospective studies (n =10). Surgical management consisted of either femoral artery ligation (FAL) and local debridement in 414 cases (78%) or local debridement plus primary revascularisation (LDPR) using Autologous vein/artery graft 38.3%, cryopreserved 1.6% or synthetic graft 60.1% in 115 cases (22%). LDPR group was associated with higher amputation rate 11% compared to FAL group 6%. Mortality rate is 2.6% in LDPR group compared to 0.7% in FAL. However, claudication incidence was higher in FAP 23.4% compared to 7.8% in the LDPR. In the LDPR group, using of vein/artery graft or Patch was associated with the lowest amputation rate (4%) and claudication incidence (2%) with mortality rate of 2%. Conclusion: Primary femoral artery ligation remains the first and safest option for management of intravenous drug abusers' groin pseudoaneurysms. However, in selected patients with an adequate autologous conduit, primary revascularization has a better outcome in term of amputation and claudication rate. Disclosure: Nothing to disclose