BACKGROUND: Infected false femoral aneurysm (IFFA) is a life-threatening complication of intravenous drug abuse and presents a difficult management problem for the vascular surgeon. Controversy exists regarding the best management. The choice lies between ligation and excision with immediate revascularization, and ligation and excision with observation; reconstruction is reserved for critical ischaemia. METHODS: After disappointing results with the former method it was decided to perform ligation and excision with observation as the initial treatment of IFFA. A 9-year experience of 28 patients treated at this hospital is reviewed. RESULTS: In 26 cases of primary ligation and excision of an IFFA there were no amputations and patients described claudication only in follow-up. In two cases of a second IFFA in the same limb, repeat ligation and excision resulted in one viable limb with claudication only and one above-knee amputation for non-viability. At 9-year follow-up (80 per cent complete), over 90 per cent of the patients were still drug abusers and therefore not suitable for revascularization. There were two deaths, both of which were drug related. CONCLUSION: Ligation and excision of an IFFA is simple, effective and safe, and is the most appropriate method of dealing with these challenging patients.

Backgrounds and AimsLong term central venous access for Home Parenteral Nutrition (HPN) is associated with catheter related complications. The most studied and well known of these is Catheter Related Blood Stream Infection (CRBSI).This paper looks at other venous access complications, including blocked and damaged catheters, catheter related thrombosis and CRBSI. This paper will also present treatment outcomes for each of these complications. This paper will also examine if there are any correlating patient or catheter related factors that can help predict future catheter related complications. By demonstrating the treatment outcomes for each line complication, it is hoped this will contribute to the literature that could be used for standard setting in complications related to long term central venous access. MethodsHPN data was analysed from the Greater Glasgow and Clyde (GGC) Home Parenteral Nutrition Database (HPN) which is a comprehensive, prospectively maintained electronic record of all HPN patients treated in GGC. The time period of data collection was 1998-2017. Descriptive statistics were used to report data frequency, age, and catheter days' distributions. Data were not normally distributed and so non-parametric tests were used.Spearman's Rho correlation was used to measure correlation between two numeric groups. Catheter complications were reported as a rate in count data, meaning that more than one event could be recorded per patient, with 1,000 catheter days as the person-time denominator. Poisson means test and Fisher exact tests were used to compare different rates, as complications were treated as count data increasing over variable total time periods. P < 0.05 with 95% confidence interval (CI) was considered significant in all tests. Comparisons between binary data sets used 2 sample t-test to compare the groups. ResultsFrom 169 patients, 101 (59.8%) were female and 68 (40.2%) were male. The age when first starting HPN ranged from 16 to 79 years old with a median of 56 years. Total catheter days was 173,151 derived from 408 catheter insertions on 169 patients. 282 complications occurred in 85 patients over the study period. An overall catheter complication rate of 1.62/1000 days was found. 84 patients did not experience a single complication. There were 171 proven catheter infections in 66 patients over the study period. Infection rate from the entire period of report was 1.35 infections/1000 catheter days. This decreased over time. Infection was found to be correlated with length of time on HPN, catheter location, catheter diameter and use of Taurolock-Hep100. Thrombosis (n=16) was associated with total time on HPN(r 2 = 0.187, P <0.05) and the number of infections (r 2 = 0.207 P <0.05). Damage was strongly associated with increasing time on HPN with (r 2 of 0.494 and P <0.005). Blockage was not associated with any patient or catheter factors. Overall catheter salvage rate for CRBSI by antibiotic treatment was 61.87%.Success varied according to organism cultured. Catheter salvage was less succe...

EDITOR,-We write to draw attention to complications resulting from the new "abuse resistant"' formulation of temazepam capsules. In the past six months we-have seen 15 injecting drug misusers (13 men, two women, aged 19-35) with severe complications of intra-arterial injection (10 femoral, five brachial) of "solid" gel temazepam. Patients prepared the capsules by removing the soft gelatin shell, boiling the "solid" gel centre with water in a spoon, and injecting the warm suspension. All described instant pain in the region supplied by the injected artery.

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