An atrial transseptal approach was used for embolization of a pulmonary arteriovenous aneurysm in a 56-year-old man with hereditary hemorrhagic telangiectasia. Two previous attempts at embolization of the aneurysm failed because of an inability to cannulate the feeding vessel. A transseptal puncture was performed to gain access to the left superior pulmonary vein allowing retrograde cannulation of the venous sac and successful coiling of the aneurysm without complications. Transseptal transcatheter coiling is a feasible method of treating pulmonary arteriovenous malformations if access to the feeding artery cannot be gained by a standard approach.
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