Reply

Abstract

Our current experience treating drug-related infected false aneurysms of the femoral artery exceeds 75 patients, with several years follow-up on many patients. Despite an open-minded reading of the letter and article of Patel et al.,1Patel KR et al.Routine revascularization with resection of infected femoral pseudoaneurysms from substance abuse.J Vasc Surg. 1988; 8: 321-328PubMed Scopus (62) Google Scholar based on the lessons learned from this large experience, I find no compelling reason to recommend deviation from the treatment plan outlined in our report2Reddy DJ et al.Infected femoral artery false aneurysms in drug addicts: evolution of selective vascular reconstruction.J Vasc Surg. 1986; 3: 718-724PubMed Scopus (88) Google Scholar and editorial.3Reddy DJ Treatment of drug-related infected false aneurysm of the femoral artery—Is routine revascularization justified?.J Vasc Surg. 1988; 8: 344-345PubMed Scopus (21) Google Scholar In regard to amputation rates, Patel et al. compare the results they achieved treating selected patients with results achieved by other authors treating all patients.2Reddy DJ et al.Infected femoral artery false aneurysms in drug addicts: evolution of selective vascular reconstruction.J Vasc Surg. 1986; 3: 718-724PubMed Scopus (88) Google Scholar, 4Feldman AJ Berguer R. Management of an infected aneurysm of the groin secondary to drug abuse.Surg Gynecol Obstet. 1983; 157: 519PubMed Google Scholar, 5Johnson JR Ledgerwood AM Lucas CE. Mycotic aneurysm: new concepts in surgery.Arch Surg. 1983; 118: 557Crossref PubMed Scopus (145) Google Scholar To make a valid comparison, two of the 16 patients (12.5%) treated required an early amputation in their series. In the selected group treated by prior extraanatomic bypass, only one of 15 patients needed an early amputation.1Patel KR et al.Routine revascularization with resection of infected femoral pseudoaneurysms from substance abuse.J Vasc Surg. 1988; 8: 321-328PubMed Scopus (62) Google Scholar Comments relating to our earlier report2Reddy DJ et al.Infected femoral artery false aneurysms in drug addicts: evolution of selective vascular reconstruction.J Vasc Surg. 1986; 3: 718-724PubMed Scopus (88) Google Scholar are best answered by providing follow-up on two specific patients. The first underscores the importance of long-term follow-up. A translumbar aortogram (Fig. 1) from a drug-addicted patient who had graft sepsis 2 years after the placement of a left obturator foramen bypass shows that the patient's continued drug use caused an infected false aneurysm of the distal anastomosis necessitating removal of the prosthesis.As expected, amputation was not required even though further arterial reconstruction was not undertaken. Another patient had ligation of a disrupted vein autograft in the exposed bed of a resected infected false aneurysm of the femoral bifurcation. Follow-up shows the wisdom of avoiding arterial reconstruction for the indication of claudication, even though the patient had a systolic ankle/brachial index of 0.2 and initially experienced severe claudication. After 5 years collateral arterial flow has increased his ankle/brachial index to 0.8. His claudication is mild and arterial reconstruction has not been required. The patient remains an active drug user. Patients with drug-related infected false aneurysms present both acute and chronic treatment problems related to limb sepsis and continued or recidivate drug use. Accordingly, placement of synthetic arterial grafts in drug users should be undertaken with extreme caution, particularly when the indication for reconstruction is claudication.