Outcomes of Ligation without Revascularization in Pseudoaneurysms of Peripheral Arteries in Intravenous Drug Users

• Main Authors: Lokesh Shekher Jaiswal, Narendra Pandit, Shailesh Adhikary
• Format: Article
• Language: English
• Published: Nepal Medical Association 2019-06-01
• Series: Journal of Nepal Medical Association
• Subjects: intravenous ligation; peripheral artery; pseudoaneurysm; substance abuse.
• Online Access: https://www.jnma.com.np/jnma/index.php/jnma/article/view/4472
• ISSN: 0028-2715; 1815-672X

Introduction: Management of pseudoaneurysms in intravenous drug users is complex and challenging due to an associated infection and unavailability of autologous vein grafts. Here we observe the outcomes of ligation and local debridement as a primary modality of treatment in this subset of patients with pseudoaneurysms. Methods: This is a descriptive cross sectional study of 15patients over a period of 4 years who presented with pseudoaneurysm of peripheral artery from intravenous drug use. In this study, we describe the presentations and management outcomes in 15 patients with peripheral arterial pseudoaneurysmfrom IV drug use. Results: The most common site involved was common femoral artery among 12 (80%) patients followed by superficial femoral artery among 8 (13.3%) patients and external iliac artery in 1 (6.7%) patient. Twelve (80%) patients were having signs of infection. All patients underwent surgical intervention which comprised of excision of pseudoaneurysm and ligation of artery without revascularization among 12 (80%) patients and with revascularization with autologous venous graft among 3 (20%) patients. There was no mortality or a major bleeding requiring re-exploration. None of the patients developed limb ischemia necessitating amputation.One patient with femoral artery ligation without revascularization at one year of follow up is having claudication on brisk walking. There was one saphenous vein graft thrombosis in immediate postoperative period. Conclusions: With the use of ligation without revascularization technique, there was no mortality or major bleeding requiring re-exploration. None of the patients developed limb ischemia necessitating amputation so this treatment modality seems promising in treatment of pseudoaneurysms in intravenous drug users.