In Reply to: Re: Case 0400_10 -- Recurrent Pseudoaneurysm and Arteriovenous Fistula Following Embolization posted by Frank Lynch on April 16, 2000 at 08:29:10:
I have seen a case almost identical to the one presented. Also from a GSW to the thigh. The AVF was probably there previously and now thrombosed but not before inciting ischemia in the limb due to the shunting. Ischemia is probably the most potent angiogenesis agent around and the recruitment would have begun immediately. Unfortunately, there are no easy fixes. I suggest that all the arterial inflow vessels be selectively angio'd and if any feed the nidus, ablate them with alcohol. Treat this as an AVM. I would also be loathe to use thrombin. I believe that plain old embolization of the aneurysm is better. The role for surgery here is also dubious.