Intraplug coils delivery for fast closure of giant arteriovenous fistulas (AVFs) aneurysm in dialyzed patient

Aneurysm of arteriovenous fistulas (AVFs) created for hemodialysis, could be related with several complications including steal syndrome and cardiac abnormalities, requiring thus a fast closure. Considering the high comorbidity of surgical closure, percutaneous endovascular occlusion could be considered as effective and safe treatment. A 58-year-old white male with AVF aneurysm was treated endovascularly, using a combined approach with Amplatzer Vascular Plug II (AVP II) and intraplug coils delivery pricking directly and percutaneously the plug with a 20 G spinal-needle to obtain a fast closure and improving AVP thrombogenicity. To avoid the risk of migration due to the large diameter of these aneurysm, AVP was deployed at the narrowest point of AVFs, exploiting the maximum diameter of the plug using arteriography and fistulography. Patient described quick improvement of initial symptoms and during the follow-up a complete remission of initial symptoms, and no cases of plug migration were observed. There were no late complications related to insertion of the AVP with the coils. Our case report suggests that the endovascular approach is a feasible and safe technique also for the treatment of AVFs giant aneurysm which requires urgent treatment when open surgery is contraindicated.