title: Management of Iatrogenic Pseudoaneurysms in Patients Undergoing Coronary Artery Bypass Grafting.
abstract: OBJECTIVE
  A plethora of papers have been written regarding postcatheterization femoral pseudoaneurysms. However, literature is lacking on pseudoaneurysmal management in patients undergoing coronary artery bypass grafting (CABG). Thus, we examined if pseudoaneurysms with subsequent CABG can be managed with the same strategies as those not exposed to the intense anticoagulation accompanying CABGs.
  
  
  METHODS
  During a 14-year study period, we retrospectively examined femoral iatrogenic pseudoaneurysms (IPSAs) diagnosed postheart catheterization in patients having a subsequent CABG. Patient information was obtained from electronic medical records and included pseudoaneurysm characteristics, treatment, and resolution. Outcomes of interest included the occurrence of IPSA treatment failures and complications.
  
  
  RESULTS
  In the 66 patients (mean age, 66 ± 11 years, 46% male) meeting inclusion criteria, mean dose of heparin received during the CABG procedure was 34 000 ± 23 000 units. The IPSA size distribution was the following: 17% of IPSAs measured <1 cm, 55% between 1 and 3 cm, and 21% measured >3 cm. Pseudoaneurysms were managed with compression, duplex-guided thrombin injection, and surgical repair (1%, 27%, and 26% of cases, respectively). Thrombin injection and surgical repair were 100% effective at treating pseudoaneurysms, with 1 patient experiencing a surgical site infection postsurgical repair. Observation-only management was employed in 30 (45%) patients. Nine of 30 patients with no intervention beyond observation had duplex documented resolution/thrombosis during follow-up. One patient initially managed by observation required readmission and surgical repair of an enlarging pseudoaneurysm (6 cm growth) following CABG.
  
  
  CONCLUSIONS
  Management of pseudoaneurysms in patients prior to CABG should be similar to those patients not undergoing intense anticoagulation. In appropriate cases, small aneurysms can be safely observed, while thrombin injections are effective and safe as well. Thus, routine open surgical repair is not routinely required in patients with femoral pseudoaneurysms at time of CABG.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA pstone0627@yahoo.com.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Stone
authors.affiliation: Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Thompson
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV, USA.
authors.forename: Brent
authors.initials: B
authors.lastname: Hanson
authors.affiliation: Charleston Area Medical Center Health Education and Research Institute, Charleston, WV, USA.
authors.forename: David
authors.initials: D
authors.lastname: Masinter
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D000925:Anticoagulants / Q000627:therapeutic use; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D001026:Coronary Artery Bypass / Q000009:adverse effects; D057286:Electronic Health Records; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006801:Humans; D007049:Iatrogenic Disease; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D011312:Pressure; D011677:Punctures; D012086:Reoperation; D012189:Retrospective Studies; D013917:Thrombin / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D057772:Vascular System Injuries / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D057832:Watchful Waiting
chemical_list: D000925:Anticoagulants; D013917:Thrombin
keywords: duplex-guided interventions; iatrogenic; pseudoaneurysm