Treatment of infected pseudoaneurysm in drug abusers: ligation or reconstruction?

Recently, there has been an increase in the incidence of major vascular complications such as infected pseudoaneurysm due to intravenous drug use. For better understanding of the existing controversies regarding the optimal surgical management of infected pseudoaneurysm, the present study was conducted. Medical charts of 36 consecutive patients who underwent surgery in Taleghani Hospital, Tehran, Iran from 1996 through 2003, were retrospectively analyzed. We studied the hospital records of 33 cases; two patients had bilaterally infected pseudoaneurysms and one underwent an emergency reoperation. The total number of operations was 36. Eleven cases (30.5%) underwent ileofemoral reconstruction and 25 (69.5%) arteries were ligated. All patients presented with infected femoral or brachial pseudoaneurysms due to intravenous drug abuse. Postoperatively, there was no hemorrhage, vascular thrombosis, amputation, or mortality. Three cases (8%) had incisional infections (2 [18%] after reconstruction and 1 [4%] after ligation operation) and 7 patients (19%) had claudication (all after ligation). Ligation is the optimal management for infected pseudoaneurysm, because it is easy, cost-effective, and safe. Reconstruction is not recommended, because of an extended infection at the location of pseudoaneurysm and at the artificial graft site.