Management of Femoral Pseudo-Aneurysm in Intravenous Drug Abusers: 20-Years Experience Publisher Pubmed



Salimi J ; Ramandi A ; Behzadi M
Source: BMC Surgery Published:2026

Abstract

Background: Femoral artery pseudoaneurysms are a serious and increasingly common complication among intravenous drug users (IVDUs), often requiring urgent surgical intervention due to infection and hemorrhage. Despite numerous treatment approaches, the optimal surgical strategy remains uncertain, particularly regarding the balance between infection control and limb preservation. Objectives: This study aimed to evaluate and compare the outcomes of ligation versus vessel repair in the surgical management of infected femoral pseudoaneurysms among IVDUs over a 20-year period at a single tertiary care center. Methods: We conducted a retrospective review of 88 male patients with femoral pseudoaneurysms secondary to intravenous drug use, treated between 2000 and 2020. Patients underwent either ligation alone (Group A) or primary arterial reconstruction (Group B). Outcomes measured included postoperative complications, limb ischemia, need for secondary bypass, amputation, and mortality. Log-rank analysis and intergroup comparisons were performed. Results: Ligation was performed in 70 patients (79%), and vessel repair in 18 patients (21%). Group A had a complication rate of 28%, with claudication (17%) and infection (7%) being most common; 11 patients required delayed bypass, and 2 underwent amputation. Group B experienced higher early infection rates (33%) and a comparable claudication rate (17%); 6 patients required secondary bypass, and 2 required amputation. No mortality occurred in Group B, while 2 deaths were recorded in Group A. Log-rank analysis indicated higher reintervention and infection rates in the revascularization group, without a statistically significant difference in limb salvage or survival. Conclusion: Ligation remains a safe and effective first-line approach for managing infected femoral pseudoaneurysms in IVDUs, with low amputation and mortality rates. Vessel repair may be considered in selected cases but is associated with higher early complication rates. Delayed revascularization following initial infection control appears to be a prudent strategy for optimizing outcomes. © The Author(s) 2026.