**Author details**

G. Kang and K. Kang *University of Pittsburgh Medical Center/Hamot Hospital, USA* 

#### **Acknowledgement**

I acknowledge Hamot Hospital and the patients.

#### **6. References**

348 Aneurysm

**3. Signs** 

**4. Workup** 

**5. Conclusion** 

neck.

**Author details** 

G. Kang and K. Kang

of a disrupted vein graft wall (4,5).

A variety of signs related to the pathophysiology at the time of presentation may be seen. A pulsatile mass on palpation or ischemia causing a gallop rhythm may be noted. If the rupture of the aneurysm occurs then murmurs related to fistula formation or shock

EKG may show ischemia, infarction or tamponade depending on presentation (4). CXRay may show mediastinal enlargement or pleural effusion (4). Diagnostic test of choice is often coronary angiography that is the gold standard before therapeutic decision-making (5). CT or MRI scanning can also accurately define the extent and size of the aneurysm and the

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 anti-

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

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

associated complications (4). Echocardiography may show a mass as well (4).

secondary to bleeding or compression may be evident (4,5,8,9,10).

hypertensive drugs are standard of care in the treatment (4,11).

*University of Pittsburgh Medical Center/Hamot Hospital, USA* 


[15] Ho P.C., Leung C.Y.: Treatment of post-stenotic saphenous vein graft aneurysm: special considerations with the polytetrafluoroethylene-covered stent. J Invasive Cardiol 16. 604-605.2004;
