Iatrogenic Femoral Arteriovenous Fistula After Cardiac Ablation Presenting As Heart Failure: Successful Endovascular Repair

Iatrogenic femoral arteriovenous fistulas (AVFs) are an uncommon but potentially significant vascular complication following catheter-based cardiac procedures, particularly those requiring femoral access. Although most AVFs remain small and hemodynamically insignificant, high-flow fistulas may result in substantial arteriovenous shunting, leading to increased cardiac preload, reduced systemic vascular resistance, and high-output heart failure. Early recognition is essential to prevent progressive hemodynamic deterioration and cardiovascular compromise. The clinical presentation of femoral AVFs is variable and may range from asymptomatic findings to overt heart failure. Imaging plays a central role in diagnosis and therapeutic planning, with computed tomography angiography enabling anatomical characterization and angiography allowing definitive diagnosis and simultaneous intervention. We report a case of symptomatic high-flow femoral AVF after cardiac ablation successfully treated with endovascular covered stent placement. Endovascular repair achieved complete exclusion of the fistulous communication with restoration of normal arterial flow and a favorable clinical outcome. During follow-up, the patient remained asymptomatic, with sustained stent patency and no evidence of recurrent arteriovenous flow. This case highlights the importance of maintaining a high index of suspicion for vascular access-related complications in patients presenting with unexplained heart failure after catheter-based procedures. It also supports the role of endovascular repair as a safe, effective, and minimally invasive treatment strategy for symptomatic high-flow femoral AVFs.