The aim of this study was to assess the effects of ligation and excision of femoral artery pseudoaneurysm without revascularization in intravenous drug abusers presenting in the tertiary care center. MethodsThis was a retrospective study conducted at Shaheed Mohtarma Benazir Bhutto Institute, Karachi, Pakistan, and included 119 patients admitted for vascular injuries of the groin between June 2016 and June 2020. Data collected from the hospital's medical records included all intravenous drug addicts presented with mass near or at groin area only, while other pseudoaneurysm locations secondary to vascular trauma, arteriovenous fistula, and hemodialysis were excluded. SPSS Version 20.0 (IBM Corp., Armonk, NY, USA) was used for data analysis. ResultsThis study included 119 patients, all of whom presented and admitted to the Accident and Emergency Department, with a mean age of about 32 years ± 11.34 years and a mean duration of addiction of 2.47 years ± 1.37 years. Males constituted 83.2% of the patients, while females constituted 16.8%. The left femoral artery was affected more commonly than the right femoral artery, with an average of 75.6% and 24.4%, respectively. The most common presentation was bleeding from ruptured pseudoaneurysm (76.5%) and oozing with pulsatile mass (17.6%), while infected pulsatile swelling and misdiagnosis were uncommon. After surgical intervention, limb salvage was 95.8%, whereas mortality and amputation rate were 2.5 % and 1.7%, respectively. ConclusionThe optimal management of femoral artery pseudoaneurysm in intravenous drug addicts is ligation and excision of the pseudoaneurysm without revascularization.

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Methods: On examination of this thinly built patient, a pulsatile mass (0 Â 10 cm) was palpable in the periumbilical region, more on the left side. Echocardiography showed a secundum-type atrial septal defect measuring 17 mm (left to right shunt), residual perimembranous ventricular septal defect (bidirectional shunt), severe mitral regurgitation with eccentric jet, tricuspid regurgitation (moderate), and pulmonary regurgitation (mild). Computed tomography angiography of the abdomen showed leakage of contrast material from the superior mesenteric artery (SMA) into an aneurysmal sac (6.8 Â 7 cm) that occupied almost half the capacity of the peritoneum/abdominal cavity. Digital subtraction angiography showed distal SMA aneurysm with high flow; coil embolization could not be done because of the chance of gut ischemia and persistent pressure symptoms afterward; therefore, the open surgical approach was decided on.Results: On opening of the peritoneal cavity, a beating heart wrapped in mesentery with surrounding inflammation was encountered. Proximal SMA control was taken just near to the aneurysm; the sac was opened and the hematoma evacuated, and the SMA was ligated inside the aneurysmal sac. Dusky proximal bowel found intraoperatively improved after evacuation of hematoma and ligation of the SMA aneurysmal branch, suggestive of impaired circulation from pressure of the sac. No revascularization was required.Conclusions: SMA pseudoaneurysm is rarely encountered in vascular practice. An aneurysmal sac of such size with distorted anatomy is a challenge to deal with, especially in a patient with such comorbidities.

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