Management of major arteriovenous fistulas by arteriographic techniques.

Five patients with major symptomatic arteriovenous fistulas were treated between July 1976 and December 1977. In two patients the fistulas were due to trauma; in two others, malignant neoplasms; and in one patient, congenital angiodysplasia. The anatomic location or extent of each arteriovenous fistula would have made direct surgical access to the fistula sites difficult; therefore, it was elected to use arteriographic embolization techniques to attempt definitve obliteration of the fistulas. Wool-tufted wire coli emboli were used in three patients and gelatin sponge-autologous blood clot was used in two patients. These were precisely embolized to the fistula site by superselective catheterization of the feeding artery. Complete obliteration of the fistulas was achieved in each case with no morbidity. Follow-up clinical and ateriographic examination confirmed persistence of fistula closure.