**5. Conclusion**

The average time to diagnosis is 10-20 years post CABG (5) and over that time period, systemic pressures in veins and atherosclerotic disease progression is the most likely cause of aneurysm formation. Medical treatment for atherosclerotic disease is, hence, recommended as primary treatment (4,11). Antiplatelet, cholesterol lowering and antihypertensive drugs are standard of care in the treatment (4,11).

The surgical treatment is recommended for large aneurysms but is still controversial as to the size where surgery is necessary (4,11,12). The graft diameter of more than 2 cm is arbitrarily, an indication for surgery (4,5). But, thicker aneurysmal wall or excellent flow through a graft may sway towards medical therapy in borderline cases. Pseudoaneurysms are often treated surgically and distinguished by the narrow neck and ultrasound findings of a disrupted vein graft wall (4,5).

Surgery may involve ligating the aneurysmal graft (4,12,13) and placing a new graft for revascularization (most commonly). Percutaneous techniques are experimental and may include investigational use of stenting and coil embolization or placement of Amplatzer vascular plugs (14). Additionally, covered Jomed stents (Abbott) or even multiple regular stents with prolonged balloon inflation have been tried (15). Other covered stents like Arium iCAST have been tried in our catheterization laboratory. (4,15). In my practice, I have injected platinum coils with expandable hydrogel polymer directly into the pseudoaneurysms with narrow neck or through stent struts for aneurysms with wide neck.
