The nurse gave him the syringe. He pulled back on the plunger and blood returned. He asked the nurse to give him the Die Hard 33 Years 1988-2021 thank you for the memories signature shirt suture on a needle driver and a pair of Adson’s forceps and said we are closing. Only he and I realized what had just happened. It was a very large Arterio-venous malformation with thicker that normal walls of the middle muscular coat (tunica media), and an external or connective tissue coat (tunica adventitia). Which had made the almost 2 inch AVF look solid on X-Ray. While closing he explained to the nurses that there would have been almost no way to have stopped the bleeding if he had made the incision and we may have very well have lost the patient.