Endovascular Repair of a Chronic AV Fistula Presenting as Post-Partum High Output Heart Failure.

•This chronic AV fistula was diagnosed 12 years after lumbar discectomy.•Only after the normal physiological state of pregnancy, and its elevated high cardiac output requirements did the patient decompensate with orthopnea and edema.•This otherwise healthy 39-year-old woman had three times the cardiac output expected which was caused by her iliac artery to iliac vein fistula.•Endovascular treatment is a viable option to cover the fistula, but the high flows can collapse and distort the stent graft during deployment.•Controlled hypotension, adenosine, ventricular pacing or proximal balloon occlusion may be appropriate if extreme flows are anticipated.