Arteriovenous Fistula Repair (and the exploding artery)

What on earth is that!?!?!?!?!  An arteriovenous (AV) fistula is a connection between an artery and a vein.  This should not occur naturally in the body.  It should go artery - capillaries - vein.  But I seem to have this connection half way down my calf and is likely the cause of my leg pain that I've had for years now.

At the end of March 2019 you may remember I had gone to hospital to have a very simple operation on my leg but just as they were doing preliminary checks they found that I had this connection and had to reconsider the operation.  Read the full blog on that here.  After this discovery was made a new action plan was put into place.

Hospital holiday to Christchurch

In August 2019, I travelled up to Christchurch from Queenstown to have the fistula repair operation.  Thankfully my good friend Tara lives in the city and had agreed to look after me for a couple of days around the operation, not that I should really need much help during recovery as it's a simple day surgery.

I wasn't feeling at all anxious about having an operation as I was distracted by having a little holiday to Christchurch, and also excited about the thought of running pain free again.  This was until I went into the operating theatre all by myself and I suddenly realised how scary it is trusting someone to put equipment into my leg!

As I was only mildly sedated, I was able to speak to the surgeon all the way through the operation and watch what happened.  It should have been complete within an hour but he struggled to get the catheter down the artery and kept having to inject more of a relaxant into the vessel to open it up.  After a couple of hours the job was done and a coil had been placed in the AV fistula to close the connection, and allow my blood to travel where it is supposed to.

I was left to recover in the hospital room with other patients that were mostly middle aged men having had some form of cardiac operation.  As I hadn't been put under general anaesthetic I wasn't too delirious but I was pretty drowsy so had a sleep for an hour or so.  Once I was fully with it again I seemed to be in more pain than all the other patients.

The pain was all around the area near my groin where the catheter had been inserted into my artery to go down to the fistula.  The opening had been closed up with a plug and I imagine it was this that was causing the pain.  I was told that I wasn't allowed out of bed for a couple of hours even though I really needed a pee.  But once I was allowed out of bed the pain of moving was so bad that it took me a few attempts to get to the toilet.  The first time I felt so faint and dizzy I had to lay back down before leaving the bedside and thought I might vomit.

After recovering enough and eating some dainty sandwiches, I was allowed to be collected by Tara.  I still didn't feel like I could fully stand up straight due to the pain around my groin so I had to be pushed out of the hospital in a wheel chair.  Before being discharged Tara was given instructions verbally and in writing about what to do in the occurrence of the artery wound opening up.  But of course this won't happen they said!!

The coil in my leg

Tara pushing me in the wheelchair

Back at Tara's house we filled our faces with Thai take away and I daren't move my hand from the plug all evening.  After an exhausting day I wanted an early night.  As I shuffled my way towards the bedroom I joked to Tara that if she hears me shout her name in the next five minutes then the artery has probably exploded.

I sat on the edge of the bed and tried to find the best way to move from sitting to laying.  A simple motion that we do daily and never even contemplate.  As I lay back, I felt more pain in my groin than I had all day.  I was told that if the artery did open up it could either bleed outside of my body in which case blood would be squirting at the ceiling, or it could bleed internally and I'd feel a lump develop by the insertion site. 

​As I'd switched the light off on the other side of the bedroom I couldn't see if anything was happening.  I couldn't feel any liquid so I assumed there was no blood spurting out.  Equally, I couldn't feel a lump so I assumed it must just be the expected level of pain and I should try to sleep.

As I tried to sleep I couldn't get over how much it hurt.  I tried to focus my thoughts on anything else but the pain was overpowering.  I kept touching the wound to see if anything was changing.  It was.  There was a lump.  "Tara!" I shouted.  She ran to the room and switched on the light.  There it was, a small lump beside the dressing of the wound which was rapidly growing in size.

We both looked at each other and realised we couldn't remember what the instructions were.  Was it press on the lump or press above the lump?  Tara got out the written instructions and after reading them we still weren't sure.  By the time we had figured out the instructions for internal bleeding care, the lump was the size of a tennis ball.  She found my pulse above it and pushed there.

Tara calmly called the emergency services and requested an ambulance. Even though Tara lives two minutes from the hospital it took the best part of an hour for the paramedics to arrive.  During that time we had gotten over the shock and were finding it pretty hilarious that she was pushing on a giant lump in my crotch while I lay in bed wearing Minion pyjamas.  

When the paramedics arrived they were pretty baffled by the whole situation and we all laughed more (even though each time I laughed I thought my wound would rip open).  My surgeon had given me his phone number so we called him and he advised that I should go to A & E. 

​Unfortunately I wasn't the only one there.  I ended up being there until 03:30 just being monitored to make sure I wasn't losing too much blood inside.  As it didn't appear too disastrous I was sent home and asked to return first thing in the morning to be fixed up again.

Interestingly, the surgeon that did the operation happened to be working in the public hospital the next day so I didn't need to explain the whole story again.  He was very quick to scan the area and glue up the hole.  After this, he wrapped me up so tight in dressing that there was no chance of anything popping open again.  Or much chance of me walking either!

During this time in A & E, I'd missed my flight back to Queenstown and had to rearrange it.  I was so tired I just wanted to sleep but couldn't physically lay down anyway.  At the airport I was pushed around in a wheelchair again as walking wasn't possible for more than a few steps.  Finally, I got home to Queenstown and spent the next seven days pretty much glued to the sofa, eating chocolate and snuggling cats!

What an adventure!!