Dual use of an amplatzer device in the transcatheter embolization of a large high-flow renal arteriovenous fistula

Embolization procedures are now considered the first-line therapy in the treatment of renal arteriovenous fistulas (AVFs). However, a risk posed by the use of these minimally invasive techniques is the migration of occluding agents into the venous and pulmonary circulations. The risk is of particular importance for larger, high-flow fistulas. The authors describe a case in which an Amplatzer Vascular Plug (AVP) was opened upstream of a renal AVF in the dilated feeding artery and used as a filter and a buttress during coil embolization to prevent coil migration during the treatment of the large, high-flow renal AVF. It was then removed and used again as the final embolic device in the renal artery, performing a dual role in the closure of the renal AVF.