Spontaneous closure of selected iatrogenic pseudoaneurysms and arteriovenous fistulae

B. Toursarkissian, B. T. Allen, D. Petrinec, R. W. Thompson, B. G. Rubin, J. M. Reilly, C. B. Anderson, M. W. Flye, G. A. Sicard, T. M. Sullivan

Research output: Contribution to journalArticle

181 Citations (Scopus)

Abstract

Purpose: We report our approach to the management of postcatheterization femoral artery pseudoaneurysms and arteriovenous fistulae in an attempt to determine the frequency of spontaneous resolution of selected lesions. Methods: We studied 196 pseudoaneurysms, 81 arteriovenous fistulae, and 9 combined lesions that were identified by duplex scan. Indications for immediate surgical repair included pseudoaneurysm greater than 3 cm, enlarging hematoma, pain, groin infection, nerve compression, limb ischemia, concomitant surgical procedure, and patient refusal or inability to comply with follow-up. All other lesions were observed. Results: One hundred thirty- nine patients underwent prompt surgical repair, and 147 patients were initially managed without operation. There were no limb-threatening complications associated with nonoperative management in this subset of patients. Eighty-six percent of the lesions being observed resolved spontaneously within a mean of 23 days, whereas 14% required surgical closure for a variety of reasons (at a mean of 111 days after the initial diagnosis). There was no statistically significant difference in the rate of spontaneous pseudoaneurysm closure (89%) as opposed to fistulae (81%) (p = 0.17). By life-table analysis, 90% of selected pseudoaneurysms had resolved by 2 months. Patients selected for observation underwent an average of 2.6 duplex scans per patient versus 1.4 scans per patient for those treated with immediate surgery (p < 0.01). Conclusion: The natural history of stable pseudoaneurysms and arteriovenous fistulae is benign and frequently results in spontaneous resolution, which allows properly selected patients to be managed without operation.

Original languageEnglish (US)
Pages (from-to)803-809
Number of pages7
JournalJournal of Vascular Surgery
Volume25
Issue number5
DOIs
StatePublished - 1997
Externally publishedYes

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False Aneurysm
Arteriovenous Fistula
Extremities
Life Tables
Groin
Femoral Artery
Hematoma
Fistula
Ischemia
Observation
Pain
Infection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Toursarkissian, B., Allen, B. T., Petrinec, D., Thompson, R. W., Rubin, B. G., Reilly, J. M., ... Sullivan, T. M. (1997). Spontaneous closure of selected iatrogenic pseudoaneurysms and arteriovenous fistulae. Journal of Vascular Surgery, 25(5), 803-809. https://doi.org/10.1016/S0741-5214(97)70209-X

Spontaneous closure of selected iatrogenic pseudoaneurysms and arteriovenous fistulae. / Toursarkissian, B.; Allen, B. T.; Petrinec, D.; Thompson, R. W.; Rubin, B. G.; Reilly, J. M.; Anderson, C. B.; Flye, M. W.; Sicard, G. A.; Sullivan, T. M.

In: Journal of Vascular Surgery, Vol. 25, No. 5, 1997, p. 803-809.

Research output: Contribution to journalArticle

Toursarkissian, B, Allen, BT, Petrinec, D, Thompson, RW, Rubin, BG, Reilly, JM, Anderson, CB, Flye, MW, Sicard, GA & Sullivan, TM 1997, 'Spontaneous closure of selected iatrogenic pseudoaneurysms and arteriovenous fistulae', Journal of Vascular Surgery, vol. 25, no. 5, pp. 803-809. https://doi.org/10.1016/S0741-5214(97)70209-X
Toursarkissian, B. ; Allen, B. T. ; Petrinec, D. ; Thompson, R. W. ; Rubin, B. G. ; Reilly, J. M. ; Anderson, C. B. ; Flye, M. W. ; Sicard, G. A. ; Sullivan, T. M. / Spontaneous closure of selected iatrogenic pseudoaneurysms and arteriovenous fistulae. In: Journal of Vascular Surgery. 1997 ; Vol. 25, No. 5. pp. 803-809.
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abstract = "Purpose: We report our approach to the management of postcatheterization femoral artery pseudoaneurysms and arteriovenous fistulae in an attempt to determine the frequency of spontaneous resolution of selected lesions. Methods: We studied 196 pseudoaneurysms, 81 arteriovenous fistulae, and 9 combined lesions that were identified by duplex scan. Indications for immediate surgical repair included pseudoaneurysm greater than 3 cm, enlarging hematoma, pain, groin infection, nerve compression, limb ischemia, concomitant surgical procedure, and patient refusal or inability to comply with follow-up. All other lesions were observed. Results: One hundred thirty- nine patients underwent prompt surgical repair, and 147 patients were initially managed without operation. There were no limb-threatening complications associated with nonoperative management in this subset of patients. Eighty-six percent of the lesions being observed resolved spontaneously within a mean of 23 days, whereas 14{\%} required surgical closure for a variety of reasons (at a mean of 111 days after the initial diagnosis). There was no statistically significant difference in the rate of spontaneous pseudoaneurysm closure (89{\%}) as opposed to fistulae (81{\%}) (p = 0.17). By life-table analysis, 90{\%} of selected pseudoaneurysms had resolved by 2 months. Patients selected for observation underwent an average of 2.6 duplex scans per patient versus 1.4 scans per patient for those treated with immediate surgery (p < 0.01). Conclusion: The natural history of stable pseudoaneurysms and arteriovenous fistulae is benign and frequently results in spontaneous resolution, which allows properly selected patients to be managed without operation.",
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AU - Allen, B. T.

AU - Petrinec, D.

AU - Thompson, R. W.

AU - Rubin, B. G.

AU - Reilly, J. M.

AU - Anderson, C. B.

AU - Flye, M. W.

AU - Sicard, G. A.

AU - Sullivan, T. M.

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N2 - Purpose: We report our approach to the management of postcatheterization femoral artery pseudoaneurysms and arteriovenous fistulae in an attempt to determine the frequency of spontaneous resolution of selected lesions. Methods: We studied 196 pseudoaneurysms, 81 arteriovenous fistulae, and 9 combined lesions that were identified by duplex scan. Indications for immediate surgical repair included pseudoaneurysm greater than 3 cm, enlarging hematoma, pain, groin infection, nerve compression, limb ischemia, concomitant surgical procedure, and patient refusal or inability to comply with follow-up. All other lesions were observed. Results: One hundred thirty- nine patients underwent prompt surgical repair, and 147 patients were initially managed without operation. There were no limb-threatening complications associated with nonoperative management in this subset of patients. Eighty-six percent of the lesions being observed resolved spontaneously within a mean of 23 days, whereas 14% required surgical closure for a variety of reasons (at a mean of 111 days after the initial diagnosis). There was no statistically significant difference in the rate of spontaneous pseudoaneurysm closure (89%) as opposed to fistulae (81%) (p = 0.17). By life-table analysis, 90% of selected pseudoaneurysms had resolved by 2 months. Patients selected for observation underwent an average of 2.6 duplex scans per patient versus 1.4 scans per patient for those treated with immediate surgery (p < 0.01). Conclusion: The natural history of stable pseudoaneurysms and arteriovenous fistulae is benign and frequently results in spontaneous resolution, which allows properly selected patients to be managed without operation.

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