Latrogenic Arteriovenous Fistula-Reply

Abstract

In Reply.— If the body of the case report of Silverstein and coauthors' article (p 309) is read closely, pericardiocentesis as a modality of therapy was not used until after the patient was treated as suggested by Dr Minuth. That would be a ten-day course of daily hemodialysis with regional heparinization and indomethacin. This patient's course was complicated by a progressive increase in the effusion, and for this reason the pericardiocentesis and instillation of steroids was instituted. This is a very important point that does not become obvious in the article but should be clearly understood: intrapericardial steroid instillation should be reserved for patients who do not respond to the more conservative modalities of therapy and who show a continued increase in the size of the effusion. As we have reported in the past, 1 anywhere between 15% to 20% of patients who have undergone hemodialysis for more than two