Objective: To investigate the method and efficacy of surgical treatment of femoral artery pseudoaneurysms secondary to injection of illicit drugs. Methods: Clinical data of 45 patients with femoral artery pseudoaneurysm caused by injection of addictive drugs were retrospectively analyzed. Of the patients, 27 cases underwent vascular reconstruction that included 20 cases of ePTFE prostheses transplantation, 4 cases of autogenous great saphenous vein transplantation, and 3 cases of endovascular covered stent exclusion, and another 18 cases were only subjected to triple ligation of the femoral artery. Results: Limb salvage was achieved in all patients. Among the patients undergoing simple vessel ligation, 3 cases developed intermittent claudication at 6 months, 2 and 3 years after surgery, and 2 cases presented limb amyotrophy and weakness at 1 year and 2 years after surgery, respectively. Among the patients undergoing vascular reconstruction, prosthetic infection occurred in 1 case and postoperative hemorrhage occurred in 4 cases shortly after surgery. Conclusion: Procedures of pseudoaneurysm resection plus extra-anatomic prosthetic bypass should be performed when the patients’ general condition permits, and triple ligation of the femoral artery is a feasible approach for patients with poor general conditions and unable to tolerate operation, or with severe local infection, but the long-term complications such as amyotrophy should be considered. Endovascular covered stent exclusion is applicable to those with no evidence of infection and/or rupture.