A 56-year-old male presented with acute bleeding from a brachial AV hemodialysis fistula blowout which was controlled temporarily with pressure – Figure 1 – arrow points to the blow out the site. This bled again when the patient was shifted from the CT scan suite. His CT angio (Figure 2 and 3) showed a pseudoaneurysm (arrows) in the venous part of the fistula with a surrounding hematoma. He was immediately taken for surgery where he bled again. A tourniquet was used at the arm to control the bleeding.
On evacuating the clotted blood the site of entry and exit were located in the aneurysmal sac. As the area was fibrotic clamps could not be applied. Bleeding which continued in spite of the tourniquet was controlled by the introduction of 2 Foley urinary catheters and inflating the balloon (Figure 4 – 1 and 2 are the two Foley catheters). The bleeding areas were then easily controlled…
