Management of an infected aneurysm of the groin secondary to drug abuse.

Fifty-three infected aneurysms of the groin in known drug abusers have been treated since 1970. There was a recent history of attempted intravenous drug injection into the femoral vein in 50 patients. Twenty-three patients underwent revascularization immediately preceding or following excision and ligation of the mycotic aneurysm. Five graft infections, resulting in one death and three amputations, occurred in this group. Three grafts became occluded, resulting in one additional instance of an amputation within six months of operation. Thirty patients underwent excision and ligation only. Five extremities were amputated in the immediate postoperative period because of irreversible ischemic changes. Six patients underwent delayed reconstruction five days to two months postoperatively because of rest pain or gangrene limited to the forefoot. No deaths and no graft infections occurred in this group. In infected aneurysms of the groin from drug addiction, we recommend initial excision with ligation and delayed selective revascularization, if indicated.