In Reply to: Re: Case 0400_10 -- Recurrent Pseudoaneurysm and Arteriovenous Fistula Following Embolization posted by Grant Price on April 19, 2000 at 16:18:21:
We see a fair number of AVF's/AVM's with enormous pseudoaneurysms or huge draining veins. The one's I see are like this one, in that they can be accessed directly percutaneously (eg. with ultrasound).
We have used different methods in each case, but usually puncture the PA or huge draining vein directly under US control, and fill the sac with coils, glue, kitchen sinks, etc. At the same time we have arterial access for control angiography, and if possible some sort of venous control, often something simple like a limb tourniquet or in the face, by having the fellow compress the jugular vein with his finger during embolization.
I have usually finished by coiling the largest arterial feeder if it is safe.
We have had had good but not great results, in that we have improved almost all the patients, but seldom get an ideal result, because the lesion has been longstanding, by the time we see the patient.