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Abstract
Infected femoral pseudoaneurysm represents a challenging problem to the vascular surgeon. Ligation or reconstruction is a debatable issue.
The study was designed to give a full knowledge about infected femoral pseudoaneurysm. It showed first the four types or causes of infected femoral pseudoaneurysm as mycotic type, microbial type, infection on top of an aneurysm or traumatic type. Clinical manifestations were explained and showed that it may be limited to fever or malaise or may be more apparent, with gangrene in an extremity following distal embolization. Complications of infected femoral pseudoaneurysm may be some claudications or it may be urgent as rupture aneurysm.
Diagnosis was classified into laboratory and radiological examinations. Management plane is mainly to prevent bleeding by ligation of the arteries, and eradicate infection by local debridement and systemic antibiotics. Direct arterial reconstruction is unfeasible due to extensive destruction of the arterial wall and when it has been attempted, it is almost universally associated with recurrent hemorrhage and infection. Proximal and distal arterial ligation with wide local debridement and excision of necrotic and infected tissue can effectively control infection and bleeding. However, the resultant limb ischaemia may be severe especially after common femoral artery ligation.
Direct arterial grafting in an infected area is often associated with recurrent infection of the graft. Extra-anatomic revascularization by transobturator bypass can be valuable limb saving procedure. A management strategy for infected femoral pseudoaneurysms includes ligation with debridement alone, ligation with routine revascularization, or ligation with selective revascularization. Arterial ligation and debridement alone are successful in selected patients if limb viability can be insured after ligation as ligation offers definitive local treatment, removes the threat of hemorrhage, and controls the septic process. It represents the simplest and the most straightforward surgical treatment for the infected femoral pseudoaneurysm.
As the main goal is life and limb salvage with least possible complications, this study recommends the simplest way of management with least complications. The simple ligation and debridement alone offers this criteria and immediate revascularization can be tolerated to those who develop critical limb ischaemia.
Keywords:
- Pseudoaneurysms
- Ligation and reconstruction