Strategic approach to embolization of coronary to pulmonary artery fistulas: a technical note

Background Congenital coronary artery to pulmonary artery fistulas (CPAFs) are extremely rare congenital vascular malformations. Purpose To give a practical approach and consider technical challenges and pitfalls for endovascular embolization of CPAF. Material and Methods Anatomic, technical, and pathophysiologic considerations are given and demonstrated for antegrade and retrograde endovascular embolization of CPAF. Results Antegrade embolization is easier to perform, saves radiation exposure, and is recommended especially in younger patients. In case of a single dominant feeder, antegrade embolization of this feeder might sufficiently treat the CPAF. Retrograde embolization from the pulmonary orifice is technically more challenging but leads to a complete and definite closure of the fistula in one single step. Conclusion Patient age and fistula configuration must be taken into consideration for appropriate treatment approach in CPAF. Prerequisite for successful embolization of CPAF is profound clinical and interventional experience, why we highly recommend to both plan and carry out embolization of CPAF as interdisciplinary procedure.