013 Differences in Arterial Stiffness Pre- and Post-Carotid Endarterectomy: Does History of Cardiovascular Disease Matter?

Abstract

very rare complication of coronary artery bypass grafting (CABG). Our objective was to determine the clinical features and management options for aortocoronary SVGAs in an effort to develop an approach to identifying and managing patients with this complication. METHODS/RESULTS: We performed a systematic review of published cases in MEDLINE and SCOPUS between 1966 and December 2010. Standardized data were extracted by two independent reviewers. We identified 209 reported cases of aortocoronary SVGAs in 168 articles. Patients were predominantly male (86.6%) and had a mean age of 65.3 10.6 years. SVGAs were identified on average 13.1 6.0 years after CABG with a mean diameter of 60.7 31.8 mm. Mechanical complications were reported in 34.0% of cases at presentation. Though most patients presented with chest pain (43.5%), SVGAs were commonly identified incidentally on imaging (35.4%). The most commonly employed investigations were cardiac catheterization (66.5%) and computed tomography (60.3%). In cases in which serial follow-up were described, nearly all aneurysms continued to increase in size. Surgical management was reported in 58.4% of cases, percutaneous intervention in 15.8%, and conservative therapy in 20.1% with short-term mortality rates of 13.9%, 6.1%, and 23.8%, respectively. CONCLUSIONS: SVGAs represent a rare but increasingly recognized complication of CABG most often seen remotely from the surgery. A large subset of patients with SVGAs are asymptomatic. It is hypothesized that the aneurysms continue to grow over time albeit at variable rates. Though further study is required, both surgical and percutaneous interventions appear to have favourable outcomes. In select patients, percutaneous management offers an alternative to repeat sternotomy.