Left heart catheterization was performed in response to progressive congestive heart failure of uncertain etiology in a 59-year-old male. The coronary arteries were normal but screening abdominal aortography revealed a large arterial venous communication between the left inferior segmental renal artery and the ipsilateral renal vein. The massive size and brisk flow patterns in the fistula presented technical challenges for transcatheter closure. The use of multiple Amplatz vascular obstructive devices (spiders) to create a matrix for securing subsequent coils in staged procedures and the patient's progress following successful closure are discussed. © 2004 Wiley-Liss, Inc.