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OBJECTIVE The objective of this study is to report an 18-year single-centre experience in the surgical and endovascular treatment of arterial complications due to self-injection in drug-abuser patients. METHODS This retrospective single-centre study was conducted analyzing a prospectively collected database including all endovascular or surgical procedures performed from January 2007 to December 2019 for any arterial complication due to self-injection in drug abuser patient. Collected data were patient demographic and comorbidity, site and type of arterial lesion (pseudoaneurysm[PA], artero-venous fistula[AVF]), signs of systemic or local infection, procedural data (endovascular/surgical treatment). Endpoints were rate of post-operative complications, re-intervention rate, limb salvage and patients' early and long-term survival. RESULTS In 11 patients (median age 36 years, range 27-47; male 73%), 13 arterial lesions were treated: 10 (77%) PA, 2 (15%) PA associated with AVF and 1 (8%) isolated AVF. Arterial lesion involved: common femoral artery in 5 (38%), superficial femoral artery in 4 (31%), profunda femoral artery in 1 (8%), brachial artery in 2 (15%) and subclavian artery in 1 (8%). Signs of infections were present in 9/13 cases (69%). The treatment was surgical in 11 (85%) cases: 7 interposition graft (6 great saphenous vein, 1 arterial cryopreserved homograft), 2 direct reconstruction, 1 patch-plasty with pericardium bovine patch, 1 arterial ligation. Endovascular treatment was performed in 2 cases: one non-infected-PA of the superficial femoral artery, and one 55-mm PA of the post-vertebral segment of the right subclavian artery with clinical sign of hemodynamic instability. At 1 month, post-operative complication rate was 8% (one lower limb claudication after superficial femoral artery ligation). Re-intervention rate was 8% (interposition graft rupture for repeated self-injections). Limb salvage and patient survival were both 100%. Median follow-up was 5 years (range 1 month -11.3 years); surgical group: median 8.2 years (range 2 month -11.3 years); endovascular group: median 3.5 months (range 1 - 6 months). During follow-up, no complications, nor re-interventions occurred, and limb salvage was 100% for both groups. At 2, 4 and 6 years, overallestimated patient survival was 91%, 81% and 81%, respectively, with no procedure-related death. CONCLUSIONS After surgical or endovascular management of arterial lesions due to self-injection in drug abuser patients, complications occur mainly in the post-operative period. During follow-up, the surgical procedures have low rate of complications, reinterventions and procedure-related mortality, whereas for the endovascular treatment the mid-term outcomes remain unknown.