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The development of three-dimensional printers has facilitated the creation of patient-specific hollow vessel models. Preoperative simulations using these types of models have improved our ability to select appropriate devices and embolic materials before performing complex endovascular procedures. This report describes 2 cases of high-flow renal arteriovenous fistulas (r-AVFs) that were successfully treated via short-segment embolization using the preloading coil-in-plug (p-CIP) technique. To our knowledge, this is the first report of r-AVF being treated using the p-CIP technique. Our findings demonstrate that preoperative simulation has the potential to improve the safety and reliability of complex vascular embolization procedures.

A 40-year-old female (gravida 3 para 1) presented with menstrual, urinary, and anal pain. Computed tomography revealed type II acquired uterine arteriovenous malformation, a common dilated venous sac with bilateral uterine arteries, and multiple branches of iliac arteries draining to the bilateral ovarian veins. Venous sac transvenous embolization via the left ovarian vein of dominant outflow was planned, since complete arteriovenous malformation occlusion was difficult with super-selective transarterial embolization of multiple feeders. Therefore, transarterial embolization of the minor feeder was performed before completing transvenous embolization using coils and 50% glue under left iliac artery flow control. Immediately thereafter, angiography confirmed the complete disappearance of the uterine arteriovenous malformation, and all pain symptoms remitted. In conclusion, transvenous embolization combined with adjunctive transarterial embolization can be an effective and radical treatment for type II uterine arteriovenous malformations.