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Percutaneous mechanical and aspiration thrombectomy techniques are increasingly being employed to treat acute iliofemoral deep venous thrombosis. Although procedural complications are rare, the incidence of inadvertent iatrogenic arteriovenous fistula (AVF) formation after endovenous mechanical thrombectomy remains unknown. Herein, we report the case of an 85-year-old morbidly obese female with multiple comorbidities referred for an edematous, cyanotic, and pulseless left lower extremity secondary to an iatrogenic femorofemoral AVF. The AVF was successfully treated via a unique through-and-through access technique by ensnarement and subsequent flossing within the injured vein.