A 65-year-old male patient was admitted to a University medical center for therapy of his progressively decreasing renal function, increasing proteinuria and enlarging arteriovenous fistula of the right kidney, first described in 2011 in a computed tomography (CT) scan. Patient history included chronic renal insuffiency and bilateral stenting of stenotic renal arteries (1997). Additional diagnoses of secondary hyperparathyroidsm, diabetes type 2, dyslipidemia, and arterial hypertension with recurring episodes of epistaxis were documented. Medication included five antihypertensives (alpha- and betablocker, angiotensin converting enzyme (ACE) antagonist, diuretic, calcium channel blocker), a sodium glucose co-transporter 2 blocker, and a statin. CT angiography (CTA) revealed double renal arteries in both kidneys, of which the more distal one of each side had been stented in 1997 using bare metal stents. No significant in-stent-stenosis could be detected at time of CTA or intervention (Fig. 1). The patient had been experiencing decreasing renal function with creatinin values of 227 umol/L and a progressively enlarging arteriovenous fistula of the stented right renal artery. Thus, increasing shunt flow was suspected responsible for renal impairment and indication for AVF occlusion was posed. The procedure was performed following an institutional standard operating procedure on a monoplane, ceiling-mounted angiographic system (Artis Q, Siemens Healthcare, Forchheim, Germany) under local anesthesia. The right femoral artery was accessed via a 6F vascular sheath (45 cm Destination® peripheral guiding sheath, Terumo Europe, Leuven, Belgium). An initial arteriogram of the upper right renal artery showed parenchymal enhancement of parts of the right kidney without signs of renal artery stenosis or AVFs. The subsequent arteriogram of the stented lower renal artery revealed the enlarged tortuous arteriovenous fistula (Fig. 1), though with restricted view of anatomic details due to the high flow in this vessel. Thereafter, a suitable diagnostic catheter was advanced through the stent into the artery and by using a 035” Rosen wire (Rosen curved wire guide, Cook Medical, Bloomington, United States of America (USA)), the sheath was advanced into the renal artery beyond the stent. For flow modulation and to achieve a stable and safe embolization position, an over-the-wire, compliant 5.5 F Fogarty occlusion catheter (Fogarty®, Edwards Lifesciences, Irvine, CA, USA) was advanced throughout the sheath into the renal artery and the occlusion balloon was inflated to the approximate size of the vessel (10 mm). The subsequent angiogram acquired through the lumen of the Fogarty catheter revealed a clear view of the afferent artery and draining vein with no parenchymal enhancement (Fig. 1). The afferent artery was probed with a microcatheter (Merit Maestro with Tenor 0.014 guidewire, Merit Medical Systems, Utah, USA) through the lumen of the Fogarty catheter as distally as possible. Detachable 3D coils (Concerto, Medtronic, Heerlen, The Netherlands) were used for framing (10 mm) and afterwards, pushable coils (VortX, Boston Scientific, Marlborough. MA, USA) for filling (4-6 mm). For complete occlusion, additional liquid embolization through the microcatheter was performed via off-label use of Histoacryl® (Histoacryl® n-Butyl Cyanoacrylate, Braun, Rubi, Spain). The microcatheter was removed and after precipitation of the glue, the occlusion balloon was deflated. During fluoroscopy, no embolization through the effernt vein was seen. Finally, two vascular plugs (AmplatzerPlug2 14 mm, Abbott Medical, Plymouth, MN, USA) were deployed through the 6 F sheath. Arteriography following embolization demonstrated occlusion of the fistula. No inadvertent distal embolization in other organs occurred and an ultrasound examination three days later documented total occlusion of the AVF. The patient was discharged with subjective well-being and is under active surveillance.