INCIDENCE AND DETERMINANTS OF LOWER LIMB SALVAGE FOLLOWING ARTERIAL LIGATION IN INFECTED PSEUDOANEURYSM IN INTRAVENOUS DRUG ABUSERS

Background: Infected femoral artery pseudoaneurysms (IFAPs) in Intravenous drug abusers (IVDAs) are very common nowadays with increasing incidence and controversial management strategy with little data about correlation between IFAPs criteria and limb outcome.
Aim of the work: to estimate incidenceand determinants of limb salvage post arterial ligation in patients with infected pseudoaneurysms.
Patients and Methods: Prospective cohortwith18 months follow up of 40 IVDA patients presented with groin pseudoaneurysms to estimate incidence and determinants of Lower Limb salvage following Arterial Ligation.
Results:Duration of Intravenous (IV) addiction ranged from half a year to 30 years and affected groin use ranged from half a year to 10 years and duration of symptoms ranged from 1 to 6 weeks. Symptoms ranged between swelling in 13 cases (32.5%), pulsating mass in 12 cases (30%) and hemorrhage in 15 cases (37.5 %). DVT found in 31 cases (77.5 %). Incidence of limb salvage post arterial ligation is 75%(N 30), threatened limbs found in 25% of cases (N 10). Amputation required in 15%(N 6) and bypass in 12.5%(N 5) bypass followed by amputation in one patient. Primary patency of all constructed bypasses is 6 months for 80% (N 4) and 3 months for 20% (N 1).Viral markers showed 33 patients were HCV +ve (82.5%), 8 patients HBV +ve (20%), 9 patients HIV +ve (22.5%). There was statistically significant difference between both groups as regard duration of affected groin use, duration of symptoms, nature of presenting symptom, Pre and immediate post-operative ABI and percent of reduction between both and Level of ligation are determinants of limb salvage
Conclusion: Ligation and debridement with selective revascularization strategy is a safe option in IFAPs management.Incidence of limb salvage following arterial ligation is 75%. Duration of affected groin use, duration of symptoms, nature of presenting symptom, Pre and immediate post-operative ABI and percent of reduction between both and Level of ligation are determinants of limb salvage.