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Background <p>Splenic artery aneurysm (SAA) with splenic arteriovenous fistula (SAVF) is rare. Endovascular embolisation offers a minimally invasive, spleen-preserving alternative to surgery, particularly in patients with connective tissue disorders. This case report describes a technically challenging proximal SAA with high-flow SAVF successfully treated using dual-balloon-assisted coil and N-butyl cyanoacrylate (NBCA) glue embolisation, with special consideration for vascular Ehlers–Danlos syndrome (vEDS).</p> Case presentation <p>A 28-year-old short-statured woman with micrognathia had computed tomography (CT) showing a partially thrombosed proximal SAA and early arterial-phase enhancement of portomesenteric veins. Given her young age and constitutional features, an underlying connective-tissue vasculopathy such as vEDS was suspected. Dual-balloon flow control was achieved using a 6 × 15&#xa0;mm Eclipse balloon at the hepatic–coeliac bifurcation (arterial inflow control) and a 12 × 40&#xa0;mm Mustang balloon in the splenic vein (venous outflow control), followed by dense coil packing and controlled NBCA injection. Post-embolisation angiography and follow-up CT demonstrated exclusion of the aneurysm–fistula complex with preserved hepatic and portal venous flows and viable splenic parenchyma.</p> Conclusion <p>Dual-balloon-assisted coil and N-butyl cyanoacrylate (NBCA) embolisation enables precise, controlled flow arrest in high-flow SAA–SAVF, minimising non-target embolisation. This case highlights its value as a safe, spleen-preserving, and durable option—particularly relevant in patients with suspected connective-tissue disorders such as vEDS, where arterial fragility mandates meticulous endovascular technique.</p> Level of evidence <p>4 (Case Report).</p> Graphical Abstract <p></p>

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A safe seal: controlled flow arrest with dual balloon protection for embolisation of a large spontaneous splenic arteriovenous fistula—a case report

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  • 发表日期：

    2026年4月16日

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  • Preethi Vijayasekar,
  • Tejesh Jagannathan,
  • Karthik Kulanthaivelu,
  • Sabarish Sekar,
  • Ansan Joseph

摘要

Background

Splenic artery aneurysm (SAA) with splenic arteriovenous fistula (SAVF) is rare. Endovascular embolisation offers a minimally invasive, spleen-preserving alternative to surgery, particularly in patients with connective tissue disorders. This case report describes a technically challenging proximal SAA with high-flow SAVF successfully treated using dual-balloon-assisted coil and N-butyl cyanoacrylate (NBCA) glue embolisation, with special consideration for vascular Ehlers–Danlos syndrome (vEDS).

Case presentation

A 28-year-old short-statured woman with micrognathia had computed tomography (CT) showing a partially thrombosed proximal SAA and early arterial-phase enhancement of portomesenteric veins. Given her young age and constitutional features, an underlying connective-tissue vasculopathy such as vEDS was suspected. Dual-balloon flow control was achieved using a 6 × 15 mm Eclipse balloon at the hepatic–coeliac bifurcation (arterial inflow control) and a 12 × 40 mm Mustang balloon in the splenic vein (venous outflow control), followed by dense coil packing and controlled NBCA injection. Post-embolisation angiography and follow-up CT demonstrated exclusion of the aneurysm–fistula complex with preserved hepatic and portal venous flows and viable splenic parenchyma.

Conclusion

Dual-balloon-assisted coil and N-butyl cyanoacrylate (NBCA) embolisation enables precise, controlled flow arrest in high-flow SAA–SAVF, minimising non-target embolisation. This case highlights its value as a safe, spleen-preserving, and durable option—particularly relevant in patients with suspected connective-tissue disorders such as vEDS, where arterial fragility mandates meticulous endovascular technique.

Level of evidence

4 (Case Report).

Graphical Abstract