{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T04:53:59Z","timestamp":1776315239496,"version":"3.50.1"},"reference-count":12,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["CVIR Endovasc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats: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\u2013Danlos syndrome (vEDS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats: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\u2009\u00d7\u200915\u00a0mm Eclipse balloon at the hepatic\u2013coeliac bifurcation (arterial inflow control) and a 12\u2009\u00d7\u200940\u00a0mm 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\u2013fistula complex with preserved hepatic and portal venous flows and viable splenic parenchyma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Dual-balloon-assisted coil and N-butyl cyanoacrylate (NBCA) embolisation enables precise, controlled flow arrest in high-flow SAA\u2013SAVF, minimising non-target embolisation. This case highlights its value as a safe, spleen-preserving, and durable option\u2014particularly relevant in patients with suspected connective-tissue disorders such as vEDS, where arterial fragility mandates meticulous endovascular technique.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence<\/jats:title>\n                    <jats:p>4 (Case Report).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1186\/s42155-026-00669-9","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T04:20:28Z","timestamp":1776313228000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A safe seal: controlled flow arrest with dual balloon protection for embolisation of a large spontaneous splenic arteriovenous fistula\u2014a case report"],"prefix":"10.1186","volume":"9","author":[{"given":"Preethi","family":"Vijayasekar","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tejesh","family":"Jagannathan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1585-8769","authenticated-orcid":false,"given":"Karthik","family":"Kulanthaivelu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabarish","family":"Sekar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ansan","family":"Joseph","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"issue":"4","key":"669_CR1","doi-asserted-by":"publisher","first-page":"439","DOI":"10.3400\/avd.cr.12.00009","volume":"5","author":"WH Ibrahim","year":"2012","unstructured":"Ibrahim WH, Endovascular M. Endovascular management of splenic arteriovenous fistula with giant venous aneurysmal dilatation. Ann Vasc Dis. 2012;5(4):439\u201344. https:\/\/doi.org\/10.3400\/avd.cr.12.00009.","journal-title":"Ann Vasc Dis"},{"key":"669_CR2","doi-asserted-by":"publisher","first-page":"386","DOI":"10.12659\/AJCR.900171","volume":"18","author":"HE Garrett Jr","year":"2017","unstructured":"Garrett HE Jr, Mack L. Coil embolization of spontaneous splenic arteriovenous fistula for treatment of portal hypertension. Am J Case Rep. 2017;18:386\u201390. https:\/\/doi.org\/10.12659\/AJCR.900171.","journal-title":"Am J Case Rep"},{"issue":"3","key":"669_CR3","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1510\/icvts.2008.196121","volume":"8","author":"R Yadav","year":"2009","unstructured":"Yadav R, Tiwari MK, Mathur RM, Verma AK. Unusually giant splenic artery and vein aneurysm with arteriovenous fistula with hypersplenism in a nulliparous woman. Interact Cardiovasc Thorac Surg. 2009;8(3):384\u20136. https:\/\/doi.org\/10.1510\/icvts.2008.196121.","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"4","key":"669_CR4","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1097\/00004836-198012000-00007","volume":"2","author":"JE Bredfeldt","year":"1980","unstructured":"Bredfeldt JE, O\u2019Laughlin JC. Portal hypertension secondary to a congenital splenic arteriovenous fistula: J Clin Gastroenterol. 1980;2(4):355\u20138. https:\/\/doi.org\/10.1097\/00004836-198012000-00007.","journal-title":"J Clin Gastroenterol"},{"issue":"7","key":"669_CR5","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.radcr.2023.04.021","volume":"18","author":"E Alexander","year":"2023","unstructured":"Alexander E, Santos E. Endovascular management of incidentally discovered splenic arteriovenous fistula resulting from ruptured splenic aneurysm: case report and review of the literature. Radiol Case Rep. 2023;18(7):12\u20132469. https:\/\/doi.org\/10.1016\/j.radcr.2023.04.021. PMID: 37235078; PMCID: PMC10206381.","journal-title":"Radiol Case Rep"},{"issue":"1","key":"669_CR6","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2023-255924","volume":"17","author":"CJ Das","year":"2024","unstructured":"Das CJ, Selvaraju A, Aggarwal P, Chumber S. Combined endovascular and percutaneous approach to the management of spontaneous splenic arteriovenous fistula. BMJ Case Rep. 2024;17(1): e255924. https:\/\/doi.org\/10.1136\/bcr-2023-255924. PMID: 38262721; PMCID: PMC10826506.","journal-title":"BMJ Case Rep"},{"key":"669_CR7","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1016\/j.jvir.2006.12.727","volume":"18","author":"D Uchiyama","year":"2007","unstructured":"Uchiyama D, et al. Coil embolization of splenic artery aneurysm with preservation of the parent artery using a neck remodeling technique. J Vasc Interv Radiol. 2007;18:447\u201350. https:\/\/doi.org\/10.1016\/j.jvir.2006.12.727.","journal-title":"J Vasc Interv Radiol"},{"issue":"10","key":"669_CR8","doi-asserted-by":"publisher","first-page":"1984","DOI":"10.3174\/ajnr.A5333","volume":"38","author":"E Piechowiak","year":"2017","unstructured":"Piechowiak E, Zibold F, Dobrocky T, Mosimann PJ, Bervini D, Raabe A, et al. Endovascular treatment of dural arteriovenous fistulas of the transverse and sigmoid sinuses using transarterial balloon-assisted embolization combined with transvenous balloon protection of the venous sinus. AJNR Am J Neuroradiol. 2017;38(10):1984\u20139. https:\/\/doi.org\/10.3174\/ajnr.A5333.","journal-title":"AJNR Am J Neuroradiol"},{"key":"#cr-split#-669_CR9.1","unstructured":"Byers PH. Vascular Ehlers-Danlos Syndrome. 1999 Sep 2. In: Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews\u00ae. 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