Sherene Shalhub, Benjamin W. Starnes, Brandon T. Garland, Anthony J. Pirot, Nam T. Tran
Vascular Surgery Division, University of Washington, Seattle, WA.
OBJECTIVES: Infected femoral artery pseudoaneurysms (IFAPs) are a significant surgical challenge and can lead to life-threatening hemorrhage or limb loss in a primarily young population.
METHODS: A retrospective review of patients who presented with IFAPs between 1997 and 2010. Demographics, initial presentation, pre-operative imaging, surgical intervention, and outcome data were recorded.
RESULTS: Fifty cases were treated during the study period. The majority were male (72%), with median age of 37 years old (range 21-63). Black tar heroin injection was the most common etiology (84%), followed by access site pseudoaneurysms (10%). Common femoral artery ligation was performed in 42 cases (84%) with preservation of the femoral bifurcation in 28 cases (56%). Vascular control was accomplished by proximal occlusion of the ipsilateral external iliac artery via a retroperitoneal incision in 24% of the cases or by selective cannulation of the ipsilateral external iliac artery from a contralateral percutaneous common femoral artery approach and placement of a compliant occlusion balloon (14%). In the remainder of the cases, the approach was via a vertical incision overlying the common femoral artery. Reconstruction for critical limb ischemia was needed in 16 cases (32%) and amputation in 7 cases (14%). Median postoperative ABI was 0.41 (range 0.23-0.70) while 30 day median ABI improved to 0.64 (range 0.26-0.93). Claudication on follow up or ischemic rest pain was documented in 23 cases (46%).
CONCLUSIONS: Simple ligation of the femoral artery and debridement of the necrotic tissue is an effective first line therapy for treatment of IFAP. This is tolerated by most patients particularly if the femoral bifurcation is preserved. Reconstruction should be reserved for those with acute limb ischemia following the ligation. Endovascular balloon occlusion of the ipsilateral external iliac artery is an effective minimally invasive technique of obtaining proximal vascular control of infected pseudoaneurysms.
AUTHOR DISCLOSURES: B. T. Garland, Nothing to disclose; A. J. Pirot, Nothing to disclose; S. Shalhub, Nothing to disclose; B. W. Starnes, Nothing to disclose; N. T. Tran, Nothing to disclose.
Posted April 2012