Trip 4

My Summary

April 14-16 2008

Treatment on Tax day! Pam, my step-mom-in-law, accompanied me this trip. After arriving in Denver, we headed downtown to meet up with Stephanie for coffee. We sat outside and had a nice little visit before she had to head back to work. Then off to Dr. Reed's office. When we made it to the hotel and crashed for a few hours, got some room service, watched a little TV, and then off to bed.

We arrived at Swedish early in the morning, only to then have the schedule switched up a little and I was the last patient of the day to go in. The waiting definately started getting to me and I ended up needing some anxiety medicine a little before actually going in for the treatment.

All went well, I felt pretty good and recovered in a normal amount of time. I definately think the long recovery from Trip 3 will be the exception and NOT the rule!

Continue to Trip 5

Medical Mumbo Jumbo

Indication: Massive left facial arteriovenous malformation, pain and swelling symptoms, intermittent bleeding, gross enlargement of the left facial area.

Report of Operation

Operation: Head and neck arteriogram procedure, extensive repair of left facial AVM in five compartments.

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 maxillary artery. Arteriograms are performed documenting extensive AVM in the facial area on the left.

At this point direct puncture was performed and access to the malformation was accomplished. Contrast was injected, angiogram performed and the study reviewed. A total of 5 ml of ethanol and one 6 mm diameter fibered Nester coil was utilized to treat that compartment.

A second area of malformation was then accessed percutaneously with an 18 gauge needle in the left facial area, contrast injected, angiogram performed and the study reviewed. Two 12 mm and two 6 mm diameter fibered Nester coils were placed and thrombosis was achieved.

A third area of the malformation was accessed percutaneously with an 18 gauge needle in the left facial area, contrast injected, angiogram performed and the study reviewed. A total of twelve 12 mm and four 6 mm diameter fibered Nester coils were placed and thrombosis was achieved.

Direct puncture was then performed with an 18 gauge needle in a fourth area of the malformation in the left facial area, contrast infected, angiogram performed and the study reviewed. Four 12mm diameter fibered Nester coils were placed and thrombosis was achieved.

Further arteriograms were performed from the external carotid artery and internal maxillary artery and a fifth area of the malformation was identified and accessed with an 18 gauge needle in the anterior chin and submandibular region. Contrast was injected, angiogram performed and study reviewed. A total of 6 ml ethanol and two 8 mm diameter fibered Nester coils were utilized to treat the AVM compartment.

At this point control angiograms were performed from the external carotid artery, internal maxillary artery, as well as the five direct puncture arteries documenting closure of the areas of AVM treated. Residual areas of the AVM were still identified. All normal branches remain intact. The procedure was then terminated.