Trip 3

My Summary

Feb 11-13 2008

Josh was able to make the trip with me again this time. Same as always- fly in, see Dr. Reed, back to the hotel, to Swedish the next morning...blah blah blah. We've got the routine down now! When I woke up in post-op, I was told that Dr Yakes had used a lot of coils this time and less alcohol. After reading the Operation Report I was surprised that "a lot of coils" actually meant 80! Holy cow!

I had a harder time recovering from this embo. I was very bruised and just lathargic. I didn't feel well or that I was getting my strength back, and was lucky that there was a holiday the following Monday so that I could take an extra day off of work. It still took a little longer to bounce back but I eventually did.

Continue to Trip 4

Medical Mumbo Jumbo

Indication: Massive left facial and submandibular arteriovenous malformation, pain and swelling symptoms, growing painful facial lesions.

Report of Operation

Operation: Bilateral facial and head and neck arteriogram procedure, repair of AVM in the anterior hin area, repair of AVM in the left facial area, repair of the left facial AVM in the submandibular region.

Complications: None

Estimated Blood Loss: Less than 5 ml

Operation Notes: ...Utilizing a micropuncture set, access to the right common femoral artery is achieved and a 4- French Terumo glidecatheter is advanced over a wire from the right common femoral artery to the right external iliac artery, right common iliac artery, abdominal aorta, thoracic aorta, aortic arch, left common carotid artery, left external carotid artery, left internal carotid artery, left facial artery, left lingual artery, right innominate artery, right common carotid artery, right external carotid artery, right lingual artery, right facial artery. Arteriograms are performed of all the branches demonstrating significant residual AVM in the submandibular, anterior chin and left facial region. Giant outflow veins are identified in the left facial AVM compartment.

At this point direct puncture is performed and the study reviewed. 5 ml of ethanol was utilized to treat that AVM compartment.

A second area of AVM was accessed in a large venous pouch in the anterior chin area and contrast injected, angiogram performed and the study reviewed. Multiple 15 mm, 8 mm, 6 mm, and 5 mm coils were placed of the Azur HydroCoil type until occlusion of that malformation compartment was successfully accomplished.

A third area of malformation was then accessed in the left facial area with an 18 gauge needle and contrast injected, angiogram performed and the study reviewed. Eight 20 mm diameter fibered Cook stainless steel coils and six 15 mm, eighteen 10 mm, and three 8 mm Azur HydroCoils were placed with additional HydroCoils until occlusion was achieved in that compartment.

A fourth area was then accessed in the submandibular area with an 18 gauge needle and contrast injected, arteriogram performed and the study reviewed. Fifteen 10 mm diameter HydroCoils of he Azur type were placed until occlusion of that compartment was achieved.

At this point, control angiograms of all four compartments documented thrombosis and the procedure was terminated. The patient was given 1 g of Ancef prior to procedure.