BACKGROUND: Infected false femoral aneurysm (IFFA) is a life-threatening complication of intravenous drug abuse and presents a difficult management problem for the vascular surgeon. Controversy exists regarding the best management. The choice lies between ligation and excision with immediate revascularization, and ligation and excision with observation; reconstruction is reserved for critical ischaemia. METHODS: After disappointing results with the former method it was decided to perform ligation and excision with observation as the initial treatment of IFFA. A 9-year experience of 28 patients treated at this hospital is reviewed. RESULTS: In 26 cases of primary ligation and excision of an IFFA there were no amputations and patients described claudication only in follow-up. In two cases of a second IFFA in the same limb, repeat ligation and excision resulted in one viable limb with claudication only and one above-knee amputation for non-viability. At 9-year follow-up (80 per cent complete), over 90 per cent of the patients were still drug abusers and therefore not suitable for revascularization. There were two deaths, both of which were drug related. CONCLUSION: Ligation and excision of an IFFA is simple, effective and safe, and is the most appropriate method of dealing with these challenging patients.