Transvenous salvage of coil migration with intraprocedural pulmonary circulation protection and successful transvenous coil embolization for the treatment of giant high-flow renal arteriovenous fistula

Transcatheter embolization is a well-established treatment for renal arteriovenous fistula (AVF) in selected cases. Transarterial approach has been the conventional route of access of the AVF. In large arteriovenous shunts, however, transarterial approach inherits the risk of distal migration of embolization material with subsequent pulmonary embolism. We report a case of giant high-flow renal arteriovenous fistula treated with coil embolization. Arterial approach was attempted with double catheter technique, however complicated with coil mass dislodgement. We have retrieved the coil mass via transvenous route with simultaneous pulmonary circulatory protection and subsequent successful transvenous coil embolization with complete obliteration of the AVF was performed.