Arteriovenous Fistula for Self-Treatment of Hemophilia

To the Editor.— I read the article by Drs. Leon N. Sussman and Harvey Lozman, "Arteriovenous Fistula for Self-Treatment of Hemophilia" (230: 437, 1974) with great interest. More than three years ago, Dr. Harold Greenberg and I reported the creation of an arteriovenous fistula for the administration of blood in a patient with von Willebrand disease and implied that this technique could be used for other intravenous medications when veins were not available ( N Engl J Med 285:787, 1971). I assume that Drs. Sussman and Lozman and the editors ofThe Journalmissed our article since it was not mentioned in the text or references. As pointed out previously by us, and now by Dr. Sussman and Dr. Lozman, the creation of an arteriovenous fistula for transfusion or intravenous medications can be a valuable procedure on selected patients.