注射毒品所致的股动脉假性动脉瘤的治疗：附45例报告

目的：探讨注射毒品所致的股动脉假性动脉瘤的外科治疗方法及效果。方法：对45例注射毒品所致的股动脉假性动脉瘤患者临床资料进行回顾性分析。其中27例进行血管重建，包括20例直接采用ePTFE人工血管移植，4例自体大隐静脉移植，3例覆膜支架腔内隔绝；18例直接采用单纯股动脉三头结扎。分析患者的近期治疗效果及随访资料。结果：所有患者均保肢成功。血管结扎术后3例分别于6个月、2年、3年出现间歇性跛行3例，2例分别于术后1年和2年出现肌肉萎缩乏力；血管重建术后近期2例出现人造血管感染和术后再出血4例。结论：患者一般情况允许时，应尽可能行假性动脉瘤切除+人工血管解剖旁路移植，但需预防近期术后再出血及感染发生；若患者一般情况差，不耐受大手术，或局部感染严重，单纯股动脉三头结扎是可行的方法，但需预防远期肌肉萎缩等并发症；覆膜支架腔内隔绝适合无明显感染且动脉瘤未破裂的患者。

Management of femoral artery pseudoaneurysm secondary to illegal drug injections: a report of 45 cases

Objective: To investigate the method and efficacy of surgical treatment of femoral artery pseudoaneurysms secondary to injection of illicit drugs. Methods: Clinical data of 45 patients with femoral artery pseudoaneurysm caused by injection of addictive drugs were retrospectively analyzed. Of the patients, 27 cases underwent vascular reconstruction that included 20 cases of ePTFE prostheses transplantation, 4 cases of autogenous great saphenous vein transplantation, and 3 cases of endovascular covered stent exclusion, and another 18 cases were only subjected to triple ligation of the femoral artery. Results: Limb salvage was achieved in all patients. Among the patients undergoing simple vessel ligation, 3 cases developed intermittent claudication at 6 months, 2 and 3 years after surgery, and 2 cases presented limb amyotrophy and weakness at 1 year and 2 years after surgery, respectively. Among the patients undergoing vascular reconstruction, prosthetic infection occurred in 1 case and postoperative hemorrhage occurred in 4 cases shortly after surgery. Conclusion: Procedures of pseudoaneurysm resection plus extra-anatomic prosthetic bypass should be performed when the patients’ general condition permits, and triple ligation of the femoral artery is a feasible approach for patients with poor general conditions and unable to tolerate operation, or with severe local infection, but the long-term complications such as amyotrophy should be considered. Endovascular covered stent exclusion is applicable to those with no evidence of infection and/or rupture.