A drug abuser developed Pseudoanerysm. Which of the following is/are should include in the treatment modalties:
Ans. A (Ligation of involved vessel & wide surgical debridement) Recon truction using graft is usually done for pseudoaneurysm (d/t other reason} but is not done in pseudoaneurysm d/t i.v drug abusers because of risk of infection of graft siteTreatment of Pseudoaneurysms (in General)# Ultrasound guided compression is the first therapeutic maneuver in non invasive vascular technology. Although it is safe but efficacy is modest, & the procedure is uncomfortable for patient& provider.# Injection of thrombin in to the pseudoaneurysm under duplex ultrasound guidance has not replaced compression as treatment for psuedoaneurysm. This technique is safe & effactive. It reduces physical effort & time requirements for the technologist & is significantly less uncomfortable for the patient.As spontaneous resolution of psuedoaneurysm has a low incidence, surgical repair has been the main therapy & remain the gold standard therapy by which all treatment modalties are comparedSurgical Intervention# Indication* Recognized Indicationrfailure of other treatment modalties, suspected secondary infection, evidence of vascular compromise, ongoing or imminent haemor-rhage & skin erosion & necrosis due to false aneurysm exapansion.* Relative Indication : Femoral neuropathy, continuous anticoagulation & a concomitant arteriovenous fistula.# Operative repair can involve simple stitch or replacement of the entire vessel with graft.# Mainstays of surgical treatment are proximal control (above the inguinal ligament if needed for extensive groin pseudoaneurys m), u se o f m ono f i lament suturefor vascular repair & debridement of devitalized tissue.# In the presence of any infection or when large residual tissue defect persists, muscle coverage with either sartorius or rectus abdominis flap over the repaired vessel must be used.Treatment of Pseudoaneurysm in i.v drug abusers -InternetLigation is optimal treatment for infected pseudoaneurysm because it is easy,safe & cost effectivefin i.v drug abuser there is high chance of infection}.Reconstruction is not recommended because of extension of infection at location of pseudoaneurysm & at artificial graft site
Ligation of involved vessel & wide surgical debridement
Exposure & ligation with subsequent revascularisation
Direct interposition graft with synthetic material in groin for revascularisation
Direct interposition graft with autogenous graft
Aneurysms