title: Ten-Year Experience of Vascular Surgeon Management of Iatrogenic Pseudoaneurysms: Do Anticoagulant and/or Antiplatelet Medications Matter?
abstract: BACKGROUND
  Previous studies examining the natural history of femoral pseudoaneurysms (PSAs) were performed before the current era of anticoagulant and/or antiplatelet therapy. The purpose of our study was to elucidate in a vascular surgeon directed approach to PSAs, the association between medication use and the failure of conservative, observation-only management.
  
  
  METHODS
  We retrospectively examined 308 femoral iatrogenic PSAs diagnosed via duplex imaging at our institution during a 10-year time period (2004-2013). Information on PSA characteristics, treatment, and antiplatelet and/or anticoagulant medication usage was obtained. We identified patients who failed observation-only conservation management, with failure defined as the need for delayed treatment because of PSAs triggered by either expansion (≥ 1 cm increase or size enlarging to ≥ 3 cm) and/or persistence (≥ 15 days).
  
  
  RESULTS
  Immediate and/or acute treatments of PSAs included 1 ultrasound-guided compression, 14 surgical repairs, and 126 thrombin injections. Of the 167 PSAs initially managed by observation only, 70 (42%) were found by ultrasound imaging to thrombosis spontaneously. An additional 70 (42%) patients had the diagnosis of PSA <3 cm and were managed conservatively with only clinical follow-up. Twenty-seven PSAs (16%) originally managed conservatively required additional treatment because of expansion and/or persistence. Patients receiving dual-antiplatelet therapy had higher rates of failed conservative management (44%) than patients not on dual therapy (9%, P < 0.01). The number of antiplatelet and/or anticoagulant medications used during observation was larger in patients failing conservative management (2.0 ± 0.7) versus patients not requiring additional intervention (1.5 ± 0.7, P < 0.01).
  
  
  CONCLUSIONS
  Most of the PSAs initially managed with observation-only did not require additional intervention. However, anticoagulant and/or antiplatelet agents use associated with PSAs required further intervention after failing observation-only management. When observation is the chosen strategy for PSA management, especially in the setting of aggressive antithrombotic and dual-antiplatelet therapy, surveillance is required to ensure proper resolution.
authors.affiliation: Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV. Electronic address: pstone0627@yahoo.com.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Stone
authors.affiliation: Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV.
authors.forename: Maria
authors.initials: M
authors.lastname: Martinez
authors.affiliation: Charleston Area Medical Center Health Education and Research Institute, Charleston, WV.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Thompson
authors.affiliation: Charleston Area Medical Center Health Education and Research Institute, Charleston, WV.
authors.forename: David
authors.initials: D
authors.lastname: Masinter
authors.affiliation: Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV.
authors.forename: John E
authors.initials: JE
authors.lastname: Campbell
authors.affiliation: Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV.
authors.forename: James R
authors.initials: JR
authors.lastname: Campbell Ii
authors.affiliation: Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV.
authors.forename: Ali F
authors.initials: AF
authors.lastname: AbuRahma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D057832:Watchful Waiting
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors