Latrogenic Arteriovenous Fistula

Abstract

To the Editor.— Dr Silverstein and co-workers' article (Archives138:308-310, 1978) entitled Iatrogenic Arteriovenous Fistula: An Unusual Complication of An Indwelling Pericardial Catheter and Intrapericardial Steroid Instillation for the Treatment of Uremic Pericarditis raises the question whether more frequent and intense dialysis with 1 or without indomethacin could have achieved a favorable outcome as well, rather than an invasive procedure. The technique of Buselmeier et al, 2 viz, the placement of an indwelling catheter with steroid application, is an extension of pericardiocentesis, pericardiocentesis with indwelling catheters, 3.4 pericardiocentesis with the instillation of steroids, 5 and a combination of these. One wonders whether any of these less extensive procedures would have sufficed to help this patient. Our experience has shown no need for pericardial fenestration or pericardiectomy with the use of frequent dialysis and indomethacin for two to four weeks. Dr Silverstein and coauthors' article may be helpful to dampen the