Coil Embolization of Femoral Pseudoaneurysms in Intravenous Drug Users: An Additional Treatment Modality

This report describes our centers' experience of a new approach using coil embolization for femoral pseudoaneurysms (PSAs) in intravenous drug users (IVDUs). Current treatment options for this challenging patient group include femoral/external iliac artery ligation and excision of the PSA, with or without revascularization. Radiological thrombin injection, endoluminal stent grafting, and coil embolization have not been widely studied in this patient group and are most commonly reserved for sterile PSAs.

A series of 6 patients who presented to the vascular surgical department with IVDU-related PSA were treated with coil embolization. We present here their clinical course and outcomes. Ethical approval was not required.

Coil embolization alone did not result in a satisfactory outcome. Thirty-three percent of patients required vessel ligation following their initial treatment with coil embolization. However, all patients initially managed with coil embolization, whether as a definitive treatment or temporizing measure to surgery, were discharged home, mobilizing well, with Doppler signals at the ankle. Postoperative claudication was present in 17% of patients. There were no amputations as a direct result of coil embolization. The amputation in this series resulted from triple-vessel ligation without revascularization in a patient mistaken as having a groin abscess.

Coil embolization is a potential, less invasive treatment option in selected cases of IVDU PSA. It offers an alternative therapeutic intervention, adding to the armamentarium available to tackle these often challenging patients.