Endovascular repair of subclavian artery complex pseudoaneurysm and arteriovenous fistula with coils and Onyx

Treatment of subclavian artery pseudoaneurysm and arteriovenous fistula (AVF) can be challenging and carries a high risk of complications. Rare cases described in the literature have been managed with major surgery or endovascular treatment with stent graft placement. We present a patient with a large lobulated pseudoaneurysm of the subclavian artery and associated high-flow AVF near the left vertebral artery origin. Surgery was considered too risky and stent graft placement would have required occlusion of the vertebral artery. Successful endovascular repair was achieved with balloon-assisted selective embolization of the fistula with a combination of coils and Onyx.