In Reply to: Re: Case 0400_10 -- Recurrent Pseudoaneurysm and Arteriovenous Fistula Following Embolization posted by Grant Price on April 13, 2000 at 08:13:49:
Well, I can give you all some feedback since the intervention was performed.
The trauma surgeons insisted on operating and our role was limited to arterial control with an angioplasty balloon. They wanted to resect the pseudoaneurysm and ligate the AV fistula.
This turned out to be quite a mess! Our manouver of occluding arteries with the balloon was worthless. There were multiple feeders coming from all directions including SFA. This thing was out of control. At one point the surgeons had to stick 3 fingers into large bleeders to stop exanguination. The key was to control the venous side and occlude the AV fistula and only then the operation was successful. It went on for 7 hours and the patient lost 6 liters of blood. He is doing OK now but has an incision from above the groin to the mid thigh and needed a lot of transfusion blood. They ended up ligating the large veins of the leg (Wallstent option would not have been that bad after all..). Only one small arterial branch was ligated.
Who thinks that the percutaneous method would have been simpler...