One stone for two birds: Successful treatment of splenic artery aneurysm and gastric varices using endoscopic ultrasound-guided coil and glue embolization

A 70-year-old woman with a long-standing history of hepatic cirrhosis presented with an episode of hematochezia that had occurred 4 months prior to admission. During the current hospitalization, an esophagogastroduodenoscopy revealed both esophageal and GOV1-type gastric varices (GV). In addition, contrast-enhanced computed tomography (CT) demonstrated a 2.7 cm saccular splenic artery aneurysm (SAA) adjacent to the splenic hilum, with a neck of 1.2 cm, and also revealed the presence of gastric fundal varices ([Fig. 1]).

Fig. 1 Contrast-enhanced CT images showing a gastric fundal varices; b a saccular splenic artery aneurysm adjacent to the splenic hilum; c a 3D reconstruction of the splenic artery aneurysm.

Endoscopic ultrasound (EUS)-guided cyanoacrylate glue injection was performed for the GV. In the same session, EUS revealed a 2.7 × 1.8 cm SAA originating from the distal splenic artery, with active arterial “to-and-fro” and bidirectional waveform blood flow on Doppler ([Fig. 2]). Given the proximity of the SAA to the gastric fundus, EUS-guided embolization of SAA was selected. A 19-gauge fine-needle aspiration needle (G31521, Cook Medical, USA) was used to trans-fundus puncture at the SAA and then two 20 × 20 mm Tornado embolization microcoils were deployed, followed by 2 mL of cyanoacrylate glue and 1 mL of distilled water injected. Near-complete obliteration of the SAA was achieved, with patent splenic artery blood flow ([Fig. 3]). Finally, the endoscopic variceal ligation was conducted for esophageal varices. The total EUS-guided embolization of both GV and SAA was recorded as 28 minutes with no immediate complications ([Video 1]).

Fig. 2 EUS images showing a 2.7 cm × 1.8 cm SAA from the distal splenic artery with bidirectional “to-and-fro” blood flow on Doppler.

Fig. 3 EUS-guided treatment of a splenic artery aneurysm: a Injection of cyanoacrylate glue into the aneurysm using a 19-gauge fine-needle aspiration needle and b near-complete embolization of the aneurysm.

Video herunterladen

EUS-guided coil and glue embolization for simultaneous treatment of SAA and gastric varices.Video 1

Postoperative follow-up revealed that the patient was asymptomatic (denying abdominal pain or fever), with stable laboratory parameters (no leukocytosis or thrombocytopenia). Follow-up CT demonstrated optimal coil positioning within the aneurysm and absence of splenic infarction ([Fig. 4]).

Fig. 4 CT images showing a SAA prior to treatment and b near-complete obliteration of the aneurysm with well-positioned coils after EUS-guided coil and glue embolization.

EUS-guided coil and glue embolization has been previously described and proved effective for visceral arterial pseudoaneurysm[1] [2] [3]. However, this case demonstrates its successful application in the treatment of SAA, underscoring its potential as a novel, safe, and effective therapeutic alternative for the true aneurysm of the visceral artery.

Endoscopy_UCTN_Code_TTT_1AS_2AB

Contributorsʼ Statement

Baobao Wang: Data curation, Formal analysis, Visualization, Writing – original draft. Guan-Jun Kou: Conceptualization, Methodology, Visualization, Writing – original draft, Writing – review & editing. Jing-Ran Su: Data curation, Visualization. Ning Zhong: Conceptualization, Writing – review & editing.

Conflict of Interest

The authors declare that they have no conflict of interest.

• References

• 1 Kou GJ, Wang YD, Zhong N. Endoscopic Ultrasound-guided Treatment of Bleeding Due to Splenic Artery Pseudoaneurysm. Clin Gastroenterol Hepatol 2025;
• 2 Rai P, Kumar P, Hoda US. et al. EUS-guided coil and glue as a first-line treatment for visceral artery pseudoaneurysm: a long-term follow-up study with a proposed algorithmic approach (with video). Gastrointest Endosc 2025; 102: 139-142
• 3 Kou GJ, Jia XL, Zhong N. One-stop solution: diagnosis and treatment of common hepatic artery pseudoanerysm on EUS (with video). Gastrointest Endosc 2025; 101: 912-914

Publikationsverlauf

Artikel online veröffentlicht:
14. November 2025