LAUSR

BACKGROUND Femoral artery pseudoaneurysms (FA-PSAs) remain a common vascular aneurysmal pathology associated with intravascular drug use (IVDU). To date no internationally agreed consensus regarding optimal surgical management of FA-PSAs exists. The aim of this systematic review and meta-analysis was to determine the optimal surgical treatment of FA-PSAs associated with IVDU. METHODS A systematic search was undertaken following PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines identifying original studies reporting outcomes of ligation-debridement and/or excision-revascularisation of FA-PSAs secondary to IVDU. Outcomes of interest were 30-day mortality, incidence of amputation at 12 months, chronic limb threatening ischaemia (CLTI) at any follow-up appointment, reintervention and bleeding. FINDINGS A total of 39 cohort studies describing 1217 femoral artery pseudoaneurysm operative outcomes met inclusion criteria, 993 (81.6%) treated by ligation-debridement and 224 (18.4%) by excision-revascularisation. The incidence of 30-day mortality was 0.8% (n=8) and 1.3% (n=3) in the ligation-debridement and excision-revascularisation groups respectively, with only one study reporting mortality in both groups. This meta-analysis found no difference in amputation (8.89% vs 8.03%, OR 0.74 95% CI 0.35-1.56, P=0.42, 11 studies) or CLTI (21.5% vs 12.4%, OR 1.24 95% CI 0.35-4.38, P=0.74, 9 studies) following ligation and debridement compared with excision and revascularisation. There was a higher incidence of reintervention (24.7% vs 10.6%, OR 0.31 [ 95% CI 0.16, 0.62, P=0.0009, 13 studies) and rebleeding (7.1% vs 1.6%, (OR 0.61 [95% CI 0.16, 2.38], P=0.48, 5 studies) following excision and revascularisation compared with ligation alone. CONCLUSION For treatments of IVDU related FA-PSAs, this study suggests no significant difference in association of mortality, incidence of amputation, or chronic limb threatening ischaemia with ligation-debridement or excision-revascularisation, but a significantly higher reintervention rate and greater rebleeding rate for revascularized patients.