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

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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. Download Video 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 Endoscopy E-Videos https://eref.thieme.de/e-videos E-Videos is an open access online section of the journal Endoscopy , reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high-quality video and are published with a Creative Commons CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission process. We grant 100% waivers to articles whose corresponding authors are based in Group A countries and 50% waivers to those who are based in Group B countries as classified by Research4Life (see: https://www.research4life.org/access/eligibility/ ). This section has its own submission website at https://mc.manuscriptcentral.com/e-videos . Publication History Article published online: 14 November 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/). Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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