Transcatheter coil embolization of an idiopathic systemic-to-pulmonary artery fistula using a combined systemic arterial and pulmonary arterial approach

Systemic-to-pulmonary artery fistula is a rare vascular anomaly characterized by a direct communication between the systemic and pulmonary arteries, carrying a risk of rupture and life-threatening hemoptysis, for which transcatheter embolization has been proposed as a minimally invasive treatment option. We report a case of a 46-year-old woman with an incidentally detected idiopathic SA-PAF arising from a tortuous mediastinal branch of the aorta and forming a fistula with the A7 pulmonary artery of the right lower lobe. Due to the high tortuosity of the feeding artery, embolization from the systemic side alone was anticipated to result in incomplete occlusion due to persistent retrograde flow from the pulmonary arterial side. We therefore performed coil embolization via a combined approach from both the systemic and pulmonary sides. Complete obliteration was achieved without complications, and magnetic resonance angiography at 3 months confirmed no residual flow.