Post-Operative Ischemia and Surgical Technique Affect Late Mortality of Femoral Artery Pseudoaneurysms Following Injection Drug Use

Abstract

Surgical management of infected common femoral artery (CFA)1 pseudoaneurysms arising from intravenous drug use (IVDU)2 is clinically challenging with excellent perioperative outcomes reported for a number of techniques. Long-term outcomes after arterial ligation versus revascularization are not known. We report both short- and long-term comparison of lower extremity perfusion and outcomes for 25 patients that underwent simple or more extensive ligation, or revascularization treatment. A retrospective analysis of 25 consecutive patients presenting primarily with infected CFA pseudoaneurysms related to IVDU at one referral institution was performed to determine short- and long-term outcomes at time of discharge, 30-days, and 1-year, including intraoperative differences, post-operative and follow-up ankle brachial index (ABI)3, bacteriology, and post-operative mortality. In addition to a direct comparison between the revascularization patients (n=12) and simple ligation patients (n=13), a comparison within the simple ligation group was performed between those who underwent a ligation of the common femoral artery with preservation of the femoral bifurcation (double ligation) and those who underwent ligation of the common femoral, superficial femoral and profunda femoral artery individually, (triple ligation) RESULTS: All techniques resulted in similar mortality at 30 days. Lower extremity perfusion at discharge was highest in the revascularization group, and lowest in the triple ligation patients. One year mortality was significantly higher in the triple ligation cohort. This is the first report of long-term outcomes after surgery for infected CFA pseudoaneurysms, and demonstrates increased late mortality in patients treated with extensive (triple) ligation with persistent ischemia. We conclude that revascularization after resection of infected CFA aneurysms, or surgical techniques that preserve or recreate the femoral artery bifurcation cause less ischemia and late mortality in these challenging patients.