Artery Ligation for Infected Femoral Pseudoaneurysms Does Carry a High Risk of Major Amputation.
Adult
Amputation, Surgical
Aneurysm, False
/ diagnostic imaging
Aneurysm, Infected
/ diagnostic imaging
Clinical Decision-Making
Computed Tomography Angiography
Databases, Factual
Female
Femoral Artery
/ diagnostic imaging
Humans
Length of Stay
Ligation
Male
Middle Aged
Retrospective Studies
Risk Assessment
Risk Factors
Substance Abuse, Intravenous
/ complications
Time Factors
Treatment Outcome
Vascular Surgical Procedures
/ adverse effects
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
18
08
2018
revised:
12
10
2018
accepted:
12
10
2018
pubmed:
8
2
2019
medline:
6
8
2019
entrez:
8
2
2019
Statut:
ppublish
Résumé
Arterial ligation has been described in the literature as a safe and effective procedure with a relatively low number of patients requiring major amputations. We performed a retrospective analysis of a prospectively held database of all patients who underwent arterial ligation for infected femoral pseudoaneurysms due to chronic intravenous drug abuse from January 2012 to March 2018. Information recorded for each patient included age, gender, blood investigations, microbiologic results, diagnostic modality, operative details, outcome of surgery, postoperative complications, and follow-up. There were 25 patients identified, with 2 of them undergoing bilateral ligations. It was more common in men (4:1), and the mean age at presentation was 39.7 years (standard deviation 8.2 y). Nine patients underwent major limb amputation for severe limb ischemia (7 transfemoral amputations and two 53 hip disarticulation). Average hospital stay was 24 days, and there was no mortality. We found a trend with a higher level of arterial ligation, leading to a higher rate of amputation. Our study is the first to show that there is a trend toward a higher risk of amputation with a higher level of ligation in this cohort of patients, and therefore, we suggest avoidance of external iliac artery ligation even at the most distal part just under the ligament, leaving the circumflex iliac vessel in circuit. Arterial ligation also carries a higher risk of major amputation than previously reported.
Sections du résumé
BACKGROUND
BACKGROUND
Arterial ligation has been described in the literature as a safe and effective procedure with a relatively low number of patients requiring major amputations.
METHODS
METHODS
We performed a retrospective analysis of a prospectively held database of all patients who underwent arterial ligation for infected femoral pseudoaneurysms due to chronic intravenous drug abuse from January 2012 to March 2018. Information recorded for each patient included age, gender, blood investigations, microbiologic results, diagnostic modality, operative details, outcome of surgery, postoperative complications, and follow-up.
RESULTS
RESULTS
There were 25 patients identified, with 2 of them undergoing bilateral ligations. It was more common in men (4:1), and the mean age at presentation was 39.7 years (standard deviation 8.2 y). Nine patients underwent major limb amputation for severe limb ischemia (7 transfemoral amputations and two 53 hip disarticulation). Average hospital stay was 24 days, and there was no mortality. We found a trend with a higher level of arterial ligation, leading to a higher rate of amputation.
CONCLUSIONS
CONCLUSIONS
Our study is the first to show that there is a trend toward a higher risk of amputation with a higher level of ligation in this cohort of patients, and therefore, we suggest avoidance of external iliac artery ligation even at the most distal part just under the ligament, leaving the circumflex iliac vessel in circuit. Arterial ligation also carries a higher risk of major amputation than previously reported.
Identifiants
pubmed: 30731219
pii: S0890-5096(19)30058-5
doi: 10.1016/j.avsg.2018.10.036
pii:
doi:
Types de publication
Journal Article
Langues
eng
Pagination
326-330Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.