Infected Femoral Pseudoaneurysms Research Articles

Comparison between covered-stents grafting and ligation in the treatment of infected femoral pseudoaneurysm due to intravenous drug abuse.

The study compared the outcomes between covered-stents grafting (CSG) and ligation of femoral artery (LFA) in the treatment of infected femoral pseudoaneurysm (IFP) caused by intravenous drug injection. From 1st January 2016 to 30th November 2021, the clinical data of patients with IFP caused by intravenous drug injection who underwent CSG (n = 31, 55.4%) and LFA (n = 25, 45.4%) are retrospectively analyzed. We compared the baseline characteristics and clinical outcomes of the two groups, including early and late mortality and morbidity. A total of 56 patients were enrolled in the study, comprising 50 (89.3%) men and 6 (10.7%) women, with a mean age of 34.3years. There was no significant difference observed between the two groups in terms of 30-day mortality (3.2% vs 0%, p = .365) and length of stay (9 [7, 12] vs 11 [8.5, 12.5]days, p = .236). However, group CSG exhibited a lower rate of intermittent claudication (0% vs 32%, p = .001), less blood loss (67.1 ± 22.5mL vs 177.0 ± 59.8mL, p < .001), and shorter surgery duration (57.5 ± 9.9min vs 84.4 ± 22.8min, p < .001) compared to group LFA. The LFA group were divided into subgroups according to the ligation site. The amputation rate of superficial femoral artery ligation group (0 vs 27.3%, p = .014) was significantly lower than common femoral artery ligation. Covered-stents grafting may be a preferable treatment to LFA for IFP due to intravenous drug abuse, particularly when the entry tear is located in the common femoral artery.

Optimal management of infected femoral pseudo aneurysm in drug addicts presenting to Benazir Bhutto Hospital, Rawalpindi.

Objective: To compare the outcomes of excision of pseudo aneurysm along with ligation and local debridement with the outcomes of excision of pseudo aneurysm along with ligation and revascularization in the management of infected femoral pseudo aneurysm among drug addicts. Study Design: Retrospective Analytic study. Setting: Surgical Unit-1, Benazir Bhutto Hospital, Rawalpindi. Period: July 2010 to July 2019. Material &amp; Method: Among patients presented with pseudo aneurysm in Surgical Emergency and out patients department. Data was collected through medical record of the hospital. P-value less than 0.05 was set statistically significant. Results: Mean age and duration of addiction for study population were 36.50 years with SD of ±6 years and 2.80 years with SD of ±0.90 years respectively. All enrolled participants were males (100%). Heroine (76%) was the most common used by addicts while other drugs included benzodiazepine (12%), amphetamine (8%), and cocaine (4%). Left sided femoral artery (70%) was more involved in pseudo aneurysm as compare to right sided femoral artery (30%). Post operative adverse events percentage for ligation without revascularization was 22.72%, whereas, it was 100% for ligation with revascularization. Mortality was 0% for excision with ligation and local debridement while it was 50% for excision with ligation and revascularization. Conclusion: For the optimal management of infected femoral pseudo aneurysm, excision with ligation and local debridement is effective in comparison to excision with ligation and revascularization among addicts.

Bare Dissection Stents Along With Covered Stents Are Superior for Aortic Repairs in All Acute Type B Aortic Dissections

Bare Dissection Stents Along With Covered Stents Are Superior for Aortic Repairs in All Acute Type B Aortic Dissections

Appraisal of Ilio-popliteal Bypass Surgery for Limb Salvage (In Patients with Critical Lower Limb Ischemia and Infected Femoral pseudoaneurysms)

Appraisal of Ilio-popliteal Bypass Surgery for Limb Salvage (In Patients with Critical Lower Limb Ischemia and Infected Femoral pseudoaneurysms)

Outcomes of Covered Stents With Vacuum Sealing Drainage For Treatment of Infected Femoral Pseudoaneurysms in Intravenous Drug Addicts

For treatment of infected femoral artery pseudoaneurysms (IFAPs) with the covered stent, debridement technique is important but frequently ignored. Our study aims to review our experience and outcomes of patients undergoing covered stents placement and debridement with vacuum sealing drainage (VSD). This study retrospectively analyzed 41 intravenous drug addicts with IFAP who received covered stent implantation and debridement with VSD from January 2015 to December 2020. The diagnosis was based on the previous history of local injection and the presence of pulsatile mass at the injection site. All cases were confirmed by CT angiography (CTA), ultrasound, or digital subtraction angiography (DSA). Technical success, time of wound care, and clinical outcomes were evaluated. Technical success was achieved in all patients. The interval from diagnosis to treatment was 26 ± 11 hours. The time of continuous drainage with VSD was 18.79 ± 6.56 days. 38 patients (92.68%) with fresh granulation tissue were sutured and discharged from the hospital. Stents in 31(91.18%) of 34 cases were patent during follow-ups. Three patients had stent occlusion caused by thrombosis, and two of them were complicated with stent infection. The two infectious stents were removed and the femoral arteries were ligated. One of them received open-surgical reconstruction with the great saphenous because of claudication. Two patients were admitted to the hospital for rebleeding caused by drug abuse relapse. Covered stents placement is convenient and rapid to control massive hemorrhage in IFAPs of intravenous drug abuse. Early debridement of infected tissue with continued VSD may shorten the time of wound care and make the incidence of stent infection relatively low. Meanwhile, the patency in a short time follow-up is acceptable. These results indicate that covered stents implantation with VSD may be a safe, effective, and feasible measure for the treatment of IFAPs.

Results of Obturator Foramen Bypass in Patients with Groin Infection and Arterial Involvement

Arterial bypass tunneling via the obturator foramen (OFB) can be performed to circumvent groin infections during lower extremity revascularization. The objective of this study is to report safety and efficacy outcomes of OFB in the setting of infected femoral pseudoaneurysms and infected prosthetic femoral bypass grafts. A multihospital, single-entity healthcare system retrospective review was conducted for all patients who underwent OFB between January 2014 through June 2020. Any patient >18 years of age who underwent OFB in the setting of groin infection with a minimum of 30 days follow-up was included in the trial. Demographic, operative, and clinical characteristics of patients were gathered during chart review. Statistical analysis was performed using Microsoft Excel and R studio. Seventeen patients underwent OFB during the defined time-period. Demographic data are presented in the first table (Demographic Characteristics). Mean American Society of Anesthesiologists score was 3.25. Mean estimated blood loss was 500 mL. Mean operative time was 307 min. Mean follow-up time was 8.5 months (range 0-35 months). In total, 41.2% patients underwent fluoroscopic-guided tunneling, and, when compared to blind tunneling, showed no difference in intraoperative complications or operative time (P value 0.3). In total, 52.9% of patients required ICU admission resulting in a mean number of 0.8 ICU days. The overall mean length of stay was 16.8 days. Two major amputations were reported during follow-up. Patient mortality within 30 days was 0%. Primary patency within 30 days was 100%. Intravenous drug use was not associated with an increased number of subsequent groin wound procedures (P value 0.3). Intravenous drug use was not associated with concomitant methicillin-resistant Staphylococcus aureus infection (P value 0.3). OFB is a safe and effective surgical option in patients who are unable to undergo anatomic tunneling during lower extremity bypass. OFB is associated with favorable rates of primary patency and amputation-free survival at midterm follow-up.

Infected femoral pseudoaneurysms in intravenous drug abusers: a decade of experience from a Singapore tertiary centre.

A pseudoaneurysm (or false aneurysm) is a haematoma that communicates with an artery through a disruption in the arterial wall. The femoral artery is the most common injection site among drug users, and infected femoral pseudoaneurysms are the most common vascular complications. A retrospective review of medical records of intravenous drug abusers (IVDAs) who presented with infected femoral pseudoaneurysms from January 2006 to December 2016 was carried out. Patients who had pseudoaneurysms due to other aetiologies or trauma were excluded. A total of 27 patients with infected femoral pseudoaneurysms were identified. The majority were male (92.6%) and of Malay ethnicity (55.6%). Median age was 50 (range 31-62) years. Commonly abused drugs were buprenorphine (or Subutex; 59.3%) and midazolam (or Dormicum; 51.9%). Groin pain and swelling (100.0%), fever (66.7%) and presence of a pulsatile mass (51.9%) were the most common presenting symptoms. Diagnosis was confirmed via computed tomography angiography in all patients. 25 patients underwent upfront arterial ligation with debridement, among whom three patients required concurrent surgical revascularisation. Only two patients underwent ultrasonography-guided thrombin injection - one eventually required surgery and the other was lost to follow-up. Postoperative complications included wound infection (42.3%), bleeding (11.5%) and necrotising fasciitis eventually resulting in limb loss (3.8%). There were no associated mortalities. Infected pseudoaneurysms in IVDAs pose a unique challenge to vascular surgeons. We found that simple ligation and debridement was a safe and effective option for such patients.

Femoral Pseudoaneurysm in IV Drug Abusers: Single-center Study Experience.

Pseudoaneurysm of the femoral artery is the most common complication among IV drug abusers who inject drugs in groin. These are usually infective and potentially fatal so it requires astute clinical recognition and prompt treatment, possessing a significant challenge to vascular surgeons. We present a retrospective descriptive study and the prevalent practice of their management covering the period from 2013 July- December 2019 at our center. Data regarding demography, presentation, surgical management, and the outcome was analyzed. Among 368 femoral pseudoaneurysm operated during the period, groin swelling with pulsatile mass was the most frequent presentation accounting 304 (82.61%) patients. About 67.12% (247 patients) of the pseudoaneurysm has purulent discharge and 60.07% (221 patients) had bleeding at presentation out of which 211patients had hepatitis C (HCV), hepatitis B (HBsAg) and/or Human Immunodeficiency virus (HIV) status positive. Thirty six patients (9.78%) presented with femoral pseudoaneurysm in both groins. Ligation and excision of the pseudoaneurysm were done in all cases while delayed revascularization was done in eight patients with expanded Polytetrafluoroethylene (ePTFE) graft in one patient and venous bypass grafts in other 7 cases. All patients after bypass had no major limb loss and two patients had a patent graft at five years follow up. There were nine mortalities and thirty two patients underwent amputation. Conclusions: Infected femoral pseudoaneurysm can be managed by ligation of the involved artery with delayed revascularization if required without major limb and life loss.

Outcomes of femoral artery ligation for treatment of infected femoral pseudoaneurysms due to drug injection

ObjectiveInfected femoral artery pseudoaneurysms (IFAPs) are a known complication of illicit intravenous drug injection. As the opioid crisis in our country continues to worsen, we will likely see more IFAPs and algorithms for management of these patients will need to be elucidated. The aim of this study was to describe the surgical management and outcomes of patients presenting with IFAPs treated with femoral artery ligation. MethodsThis is a single-center, retrospective study of consecutive patients presenting to our institution with IFAPs associated with illicit drug injection between 2004 and 2017 and treated with primary ligation. Primary end points included major adverse limb events (MALE) and death. Baseline demographics, clinical features, and long-term outcomes were recorded. ResultsOver the study period, 60 IFAPs were managed with arterial ligation in 58 patients. Fifty-two percent of patients underwent common femoral artery ligation, 30% of patients underwent a triple ligation (ligation of the common femoral artery, profunda femoris artery, and superficial femoral artery), and 18% of patients underwent ligation of the superficial femoral artery only. The average postoperative ankle-brachial index was 0.47. None of the patients underwent revascularization at the index procedure. In our early experience, four patients (6.6%) underwent delayed revascularization with a prosthetic bypass. Two of the patients subsequently re-presented with infected bypass grafts and required the only major amputations in our series. The mean follow-up was 51.3 months and four patients were lost to follow-up. No differences were identified in MALE between patients undergoing a femoral artery ligation vs a triple ligation. Nine patients (15%) died during the follow-up period and all deaths were unrelated to IFAP treatment; the mean survival from procedure to death was 28 months. ConclusionsWe describe the largest series in the United States of IFAP related to illicit drug use treated with femoral artery ligation and found it is a safe procedure associated with low MALE. Reconstruction is not recommended and is associated with graft infection. Although the mortality rate in these patients was high, it was not related to the ligation procedure.

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

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

Predictors of Limb Outcome Following Arterial Ligation of Infected Femoral Pseudoaneurysms in Drug Addicts

Predictors of Limb Outcome Following Arterial Ligation of Infected Femoral Pseudoaneurysms in Drug Addicts

Predictors of Limb Outcome Following Arterial Ligation of Infected Femoral Pseudoaneurysms in Drug Abusers

We aimed to study variables affecting limb outcome following ligation of infected femoral pseudoaneurysms in intravenous drug abusers (IVDA)in the emergency setting and to propose an algorithm for management. Prospective study. We studied short-term outcomes of 26 IVDA presenting with infected femoral pseudoaneurysms who underwent arterial ligation, hematoma evacuation, and debridement. Long-term results pertaining to limb functionality were unfeasible, as all patients were lost to follow-up. We aimed to study the potential predictors that might impact limb outcome in the emergency setting, namely: 1) mode of presentation (impending versus ruptured), 2) site of arterial ligation (above versus below inguinal ligament), 3) presence or absence of pedal Doppler flow post-ligation, and 4) ankle brachial pressure index (ABI) pre- and post-ligation. Arterial ligation without revascularization was done in 19 (73.1%) of our patients, requiring no further intervention for limb salvage during their hospital stay. Four patients (15.4%) required iliopopliteal bypass, and 3 patients (11.5%) required major amputations (2 hip disarticulations and one above-knee amputation). In total, 23 limbs (88.5%) were salvaged. Proximal arterial ligation was done below the inguinal ligament (common femoral artery) in 21 patients (80.8%), while in the remaining 5 patients (19.2%), higher ligation was done above the inguinal ligament (external iliac artery). All 19 patients who were compensated had pedal Doppler flow post-ligation, and 18 of them had arterial ligation done below the inguinal ligament. The mean preoperative ABI (±SD) was 0.87±0.34, and the mean postoperative ABI (±SD) was 0.37±0.27. The mean change in ABI (±SD) was 0.50±0.32. Arterial ligation with local debridement alone is a safe procedure and would have salvaged 73.1% of limbs in this study. However, implementing a selective approach for post-ligation revascularization and our proposed algorithm increased limb salvage rate to 88.5%. The detection of pedal Doppler flow after ligation can stratify patients in whom urgent revascularization might not be required for limb salvage. Additionally, all efforts should be made to ligate the femoral artery below the inguinal ligament to preserve important juxta-inguinal collateral branches.

Outcomes of Femoral Artery Ligation for Treatment of Infected Femoral Pseudoaneurysms due to Drug Injection

Outcomes of Femoral Artery Ligation for Treatment of Infected Femoral Pseudoaneurysms due to Drug Injection

Artery Ligation for Infected Femoral Pseudoaneurysms Does Carry a High Risk of Major Amputation

Arterial ligation has been described in the literature as a safe and effective procedure with a relatively low number of patients requiring major amputations. We performed a retrospective analysis of a prospectively held database of all patients who underwent arterial ligation for infected femoral pseudoaneurysms due to chronic intravenous drug abuse from January 2012 to March 2018. Information recorded for each patient included age, gender, blood investigations, microbiologic results, diagnostic modality, operative details, outcome of surgery, postoperative complications, and follow-up. There were 25 patients identified, with 2 of them undergoing bilateral ligations. It was more common in men (4:1), and the mean age at presentation was 39.7years (standard deviation 8.2y). Nine patients underwent major limb amputation for severe limb ischemia (7transfemoral amputations and two 53 hip disarticulation). Average hospital stay was 24days, and there was no mortality. We found a trend with a higher level of arterial ligation, leading to a higher rate of amputation. Our study is the first to show that there is a trend toward a higher risk of amputation with a higher level of ligation in this cohort of patients, and therefore, we suggest avoidance of external iliac artery ligation even at the most distal part just under the ligament, leaving the circumflex iliac vessel in circuit. Arterial ligation also carries a higher risk of major amputation than previously reported.

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

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.

FEMORAL ARTERY PSEUDOANEURYSM

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 &amp; 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.

Surgical Management of the Infected Femoral Pseudoaneurysms In Intravenous Drug Addicts

Background: Vascular system complications are an ongoing hazard of intravenous drug abuse. Patients and Method: This is a prospective study. The study was conducted on twenty patients who were presented at AL Hussein University Hospital in Cairo with infected femoral artery pseudoaneurysm over a period of eight months from Nov 2017 to July 2018. The inpatient medical charts were reviewed. Data were obtained on their demographic, clinical, management and outcome parameters. Result: Among the twenty intravenous drug users presenting with infected femoral artery pseudoaneurysms, (16) of the patients (80%) were seropositive for HCV. All were operated, with (5%) mortality. Primary ligation and debridement was the technique used almost exclusively (75%). One patient was managed by primary reconstruction by direct in-situ repair. Four patients were managed by primary revascularization through exta-anatomical bypass. Mean follow up period was three months. Conclusion: Ligation and debridement appears to be a simple, safe and effective procedure in infected pseudoaneurysms in IV drug users.

Surgical Management of the Infected Femoral Pseudoaneurysms In Intravenous Drug Addicts

Background: Vascular system complications are an ongoing hazard of intravenous drug abuse. Patients and Method: This is a prospective study. The study was conducted on twenty patients who were presented at AL Hussein University Hospital in Cairo with infected femoral artery pseudoaneurysm over a period of eight months from Nov 2017 to July 2018. The inpatient medical charts were reviewed. Data were obtained on their demographic, clinical, management and outcome parameters. Result: Among the twenty intravenous drug users presenting with infected femoral artery pseudoaneurysms, (16) of the patients (80%) were seropositive for HCV. All were operated, with (5%) mortality. Primary ligation and debridement was the technique used almost exclusively (75%). One patient was managed by primary reconstruction by direct in-situ repair. Four patients were managed by primary revascularization through exta-anatomical bypass. Mean follow up period was three months. Conclusion: Ligation and debridement appears to be a simple, safe and effective procedure in infected pseudoaneurysms in IV drug users.

根治に難渋した感染性仮性大腿動脈瘤の1例

根治に難渋した感染性仮性大腿動脈瘤の1例

Management of Femoral pseudoaneurysms in intravenous drugs users - A bubble trouble

Introduction: Femoral pseudoaneurysm in the intravenous drug users is a challenge to the treating surgeon. Surgical options range from ligation with excision to reconstruction using various kinds of grafts. However there is no generalized consensus on the optimal surgical treatment and the controversy persists.&#x0D; Methods: Medical charts of 10 consecutive patients presenting with infected femoral pseudoaneurysm of the lower limbs in emergency department,who underwent surgery in Bir Hospital from Jan 2008 to Dec 2010 were retrospectively analyzed. The patients were divided into two groups randomly based on the surgical management they had received. First was the reconstructive group and the second group underwent simple ligation of the femoral artery and excision of the pseudoaneurysm &#x0D; Results: All cases underwent emergency surgery. Extra anatomical Iliofemoral bypass was done in total of 7 cases, of which polytetrafluroethylenePTFE graft in 5 and Vein graft in 2 cases. Ligation of the femoral artery and excision of the pseudoaneurysm was done in 3 cases. In the reconstructive group 2 cases had to be operated twice for bleeding, 1 with PTFE graft and other with vein graft whereas 2 cases had late graft infection and was attributed to reinjection of drugs through the graft. All 4 cases underwent reoperation with ligation. In the second group with simple ligation and excision except for mild claudication, there were no other major complications. There was no mortality in both the groups.&#x0D; Conclusion: Intravenous drug users have high tendency to reuse femoral site for reinjection and thus arterial reconstruction maybe in jeopardy of recurrent infection and reoperation. Simple ligation with debridement and excision may prove to be a better option in cases of emergency surgery followed by delayed reconstruction if needed.