Portal vein arterialization (PVA) is a salvage technique used to preserve hepatic and biliary perfusion when hepatic arterial reconstruction is not feasible. Excessive arterioportal inflow, however, may cause clinically relevant portal hyperperfusion with ascites, gastrointestinal or biliary bleeding, and hepatic dysfunction. This technical note describes a practical interventional radiology approach to temporary, graded, and definitive endovascular flow modulation after PVA. All consecutive patients with native livers who underwent PVA at a tertiary referral center between February 2020 and February 2024 were retrospectively reviewed. Cases requiring endovascular flow reduction for portal hyperperfusion were analyzed with regard to indication, timing, technique selection, technical feasibility, and short-term clinical course. Technical success was defined as correct device deployment with immediate angiographic reduction of arterioportal inflow. Procedure-related complications were classified according to CIRSE. Six patients required endovascular flow modulation after PVA, accounting for nine procedures. Balloon occlusion with repositioning was used as a temporary measure and a hemodynamic test when definitive closure was considered premature. Stent-based flow modulation was used for graded reduction when persistent hyperperfusion required decompression but residual shunt perfusion was to be preserved. Coil embolization was used for definitive closure in refractory cases or when complete occlusion was deemed acceptable. Technical success was achieved in 7/9 procedures and clinical success in 5/9. Despite technically successful flow reduction, two patients died from septic multiorgan failure. Endovascular flow modulation after PVA is technically feasible using complementary IR strategies. Balloon occlusion is useful for temporary or test reduction, stent techniques for partial flow modulation, and coil embolization for definitive closure. Technique selection should be guided by timing after PVA, clinical presentation, and anticipated hepatic tolerance rather than by a uniform treatment algorithm.
Type II endoleak after endovascular aneurysm repair is the most common endoleak type. Identifying pre-operative anatomical features that could signal higher risk will improve surveillance post-procedure. This systematic review and meta-analysis evaluated the association between inferior mesenteric artery (IMA) diameter and type II endoleak. MEDLINE and EMBASE were searched via OVID (1946/1974 respectively to January 2025), in line with the PRISMA statement, for adult patients undergoing endovascular aneurysm repair for infrarenal abdominal aortic aneurysm with reported pre-operative inferior mesenteric artery diameter and post-operative type II endoleak outcomes. Both retrospective and prospective observational studies were eligible. Meta-analysis via a random-effects model evaluated the pooled mean IMA diameter among patients with type II endoleak and the mean difference in IMA diameter between patients with and without endoleak. The risk of bias was assessed using the Newcastle-Ottawa scale. Twenty studies met inclusion criteria; ten provided extractable quantitative data for pooling (2176 patients; 532 type II endoleaks). Assessment with the Newcastle-Ottawa scale demonstrated that the studies had scores between 6 and 8 out of 9. The pooled mean inferior mesenteric artery diameter among cases with endoleak was 2.95 mm (95% CI 2.64-3.26 mm; p < 0.01; I2 = 95%). The pooled mean difference in diameter between patients with and without endoleak was 0.50 mm (95% CI 0.36-0.64 mm; p < 0.01; I2 = 62%), indicating larger arteries in those who developed type II endoleak. Substantial heterogeneity reflected differences in endoleak definitions, imaging protocols, and measurement methods. Subsequent sac expansion and the need for reintervention were not reported uniformly across all studies, and when reported, insufficient data were available regarding these outcomes and their relation to IMA diameter. Larger pre-operative inferior mesenteric artery diameter was associated with an increased likelihood of type II endoleak after endovascular aneurysm repair. However, the clinical relevance of a 0.5 mm difference remains uncertain, particularly in view of potential inter-observer measurement variability. Multicentre randomised controlled trials are needed to define actionable thresholds for treatment, considering confounding factors and clinical significance of the endoleak.
To determine whether preoperative D-dimer and intraluminal thrombus ratio interact to predict aneurysm expansion in patients with persistent type 2 endoleak after endovascular aneurysm repair, informing candidate selection for prophylactic embolization. This retrospective single-center study analyzed 138 patients with persistent type 2 endoleak confirmed at 12-month follow-up after elective infrarenal endovascular aneurysm repair (2007-2020). The primary outcome was aneurysm expansion ≥ 10 mm within 5 years, assessed by Cox models with a D-dimer × intraluminal thrombus ratio interaction term and generalized estimating equations for continuous diameter change. Patients were stratified by median D-dimer (4.1 μg/mL) and median intraluminal thrombus ratio (41.5%). During median follow-up of 4.7 years, 27 patients (19.6%) developed the primary outcome. High D-dimer predicted expansion overall (hazard ratio 3.37; 95% confidence interval 1.39-8.21; P = 0.007). Within the high intraluminal thrombus ratio stratum, high D-dimer conferred markedly elevated risk (hazard ratio 13.06; 95% confidence interval 1.69-101.24; P = 0.014; Firth's regression: hazard ratio 8.29; P = 0.015); D-dimer was not predictive in the low intraluminal thrombus ratio stratum (P = 0.46). The three-way generalized estimating equations interaction was significant (P = 0.015); annual diameter change diverged markedly (+ 2.18 vs. + 0.04 mm/year), with a 12.6-mm difference at 60 months (P = 0.003). Preoperative D-dimer and intraluminal thrombus ratio interact to predict midterm aneurysm expansion. In patients with high thrombus burden, D-dimer identifies a high-risk subgroup and a low-risk subgroup amenable to standard surveillance. Level 3b, Retrospective cohort study.
Recanalisation of renal artery bridging stent graft thrombosis in patients with delayed ischemia lasting more than 24 h could potentially save some residual renal function. This study evaluates the technical success and short-term clinical outcomes of delayed recanalisation of bilateral or single-functioning kidneys with renal artery occlusion after endovascular repair of complex aortic aneurysms. We retrospectively analysed 11 patients treated between October 2019 and November 2024 who developed occlusion of a single functioning kidney or bilateral renal stent-graft thrombosis. Technical success was defined as recanalisation of at least one occluded renal bridging stent with restoration of blood flow to the kidney.. Clinical success was, defined by the improvement or stabilisation of residual renal function (eGFR) and delaying the need for dialysis. Delayed endovascular repair was performed for fifteen renal artery stent-graft thromboses in eleven patients.. Mean age was 68.7 ± 5 years; nine patients (81%) were male. Six patients (54%) had contained aortic rupture or aneurysms > 8 cm and were treated acutely/subacutely with off-the-shelf stent grafts; four (36%) received custom-made devices, and one a fenestrated cuff. Main symptoms included anuria (81%), nausea, diarrhoea, and flank pain (100%). Time from symptom onset to treatment ranged 24-96 h (mean 27.2 h), and mean time from index procedure to thrombosis was 10.4 months. Clinical success was achieved in 72% of cases. Nine patients required dialysis post-intervention; six were temporary, and three permanent. Perioperative complications occurred in 2/11 patients. In 55%, the cause of occlusion was undetermined. Median follow-up was 18.5 months (IQR 0-33). Delayed renal stent graft recanalisation is safe and effective, preserving renal function and avoiding dialysis in single-functioning or bilateral renal artery occlusions. Recanalisation should be considered aggressively when renal perfusion remains, regardless of occlusion duration.
To evaluate the feasibility and safety of an ultra-low-dose iodinated contrast media (CM) protocol during peripheral endovascular procedures in patients with chronic kidney disease (CKD) and chronic limb-threatening ischemia (CLTI). This prospective, two-center, observational study included consecutive patients with CLTI and renal dysfunction (eGFR < 60 mL/min/1.73m2, stages 2-4) undergoing infrainguinal revascularization over a 1-year period. The protocol utilized 1:9 or 2:8 CM-to-saline dilutions to minimize iodine exposure. Primary endpoints were technical success (revascularization using ≤ 15 mL CM) and the incidence of Contrast-Associated Acute Kidney Injury (CI-AKI), defined as a 25% increase from baseline or a 0.5 mg/dL increase in absolute sCr value, within 72 h. Secondary endpoints included procedural success, limb salvage, and freedom from clinically driven target lesion revascularization (TLR) at 6 months. Eighteen patients were enrolled, presenting advanced (Rutherford 6: 38.9%; occlusions: 38.8%) and complex infrainguinal disease (both femoropopliteal and infrapopliteal disease 27.7%; occlusions 38.8%). Technical success was 94.5%, with a mean CM volume of 10.3 ± 3.5 mL (range: 5-17 mL). Procedural success was 100%. No cases of CI-AKI occurred; one patient (5.5%) required dialysis 3 months post-procedure due to disease progression. Mean sCr and eGFR significantly improved at 72 h compared to baseline (p < 0.0001). At 6 months, limb salvage was 94.4%, TLR-free rate was 81.3% and survival was 83.3%. Ultra-low-dose iodinated CM protocol in complex CLTI endovascular treatment of CKD patients is safe and effective, achieving high technical success without evidence of renal function deterioration. Level 4, Case Series.
Endovascular options for infrapopliteal artery disease include plain balloon angioplasty (PTA), drug‑coated balloons (DCB), drug‑eluting and bare‑metal stents (DES), and atherectomy. Retrievable scaffold therapy (RST) has recently emerged as a temporary scaffolding strategy used with DCB, but its comparative effectiveness remains uncertain. A comprehensive literature search identified 21 randomized and 4 single‑arm trials (n = 3184). Eligible studies reported at least one prespecified outcome: 30‑day major adverse events (MAE), 12‑month all‑cause mortality, 6‑month clinically driven target lesion revascularization (CD‑TLR), or 6‑month major amputation. Random‑effects models generated odds ratios (ORs) with 95% credible intervals (CrIs). SUCRA values summarized treatment rankings. Atherectomy ranked best for 30‑day MAE (SUCRA 77.2%), though no treatment yielded a statistically significant reduction in the Odds Ratio. It was also associated with a significantly reduced 12‑month mortality versus PTA (OR 0.39, 95% CrI 0.15-0.90; SUCRA 97.8%). For 6‑month CD‑TLR, atherectomy (OR 0.26, 95% CrI 0.00-0.62), DCB (OR 0.42, 95% CrI 0.30-0.58), and DES (OR 0.43, 95% CrI 0.19-0.88) showed significant benefit. No treatment significantly reduced major amputation. RST showed favorable but nonsignificant reductions, indicating a smaller number of available studies, consistently ranking mid‑tier across all outcomes. Meta‑regression identified CKD and longer lesion length as predictors of higher CD‑TLR risk. Atherectomy showed the most consistent benefits across mortality and reintervention outcomes, while RST demonstrated promising but inconclusive performance. Larger randomized trials are needed to clarify RST's role in infrapopliteal revascularization.
Post-implantation syndrome (PIS) is recognized as a systemic inflammatory response following endovascular aneurysm repair (EVAR), characterized by a high frequency of occurrence and the capacity to provoke cardiovascular complications and extend the duration of hospitalization. The objective of our study is to construct a predictive algorithm through the application of machine learning (ML) techniques to forecast the onset of PIS subsequent to EVAR procedures. The data of 618 patients were retrospectively retrieved from the Electronic Health Record (EHR) system of Foshan First People's Hospital, covering the period from January 2018 to December 2022. Least absolute shrinkage and selection operator (LASSO) regression is used for data preprocessing and variable selection. Eight ML models are developed to predictive PIS after EVAR. The area under the receiver operating curve (AUC), F1-score, accuracy, sensitivity, and specificity were evaluated as the model performances. According to the exclusion criteria of 618 patients, 594 patients were finally included in the statistical analysis, and the incidence rate of PIS was 16.8%. Our research results show that there are 11 features that predict risk factors for PIS, including intraoperative use of etomidate, muscle relaxants, polyester endograf (knitted process), polyester endograf (woven process), glucocorticoids, phenylephrine, platelet count, age, absolute neutrophil count, surgical duration, and creatinine. The linear discriminant analysis (LDA) model performs the best among prediction models, with an AUC of 0.794, F1 score of 0.438, sensitivity of 0.7, specificity of 0.697, and accuracy of 0.697. Our study selected 11 preoperative and intraoperative variables to develop a ML model based on LDA for predicting PIS after EVAR and the model may help assist clinical decision-making.
Blunt thoracic aortic injury (BTAI) is the second leading cause of mortality in patients with trauma, closely following head injuries, which remain a significant concern in trauma care. Thoracic endovascular aortic repair (TEVAR) is the preferred treatment for BTAI; however, insufficient proximal sealing zone length poses a significant challenge for successful TEVAR. This study aimed to investigate the outcomes of TEVAR in patients with BTAI, including those with short proximal sealing zones (≤ 15 mm). This retrospective study included 52 consecutive patients who underwent TEVAR for BTAI in the authors' institution between January 2018 and December 2023. Patient demographics, BTAI grade, adverse events, and endoleak were assessed. Proximal sealing zone length was measured on pre-procedural computed tomography (CT). Subgroup analysis was used to compare outcomes between patients with proximal sealing zones ≤ 15 and > 15 mm. The average injury severity score was 44.1 ± 15.8, with 88.5% of patients sustaining grade 3 BTAI. One technical failure occurred owing to an acute aortic arch angle. A total of 29 patients had proximal sealing zones ≤ 15 mm, with 5 of them undergoing left subclavian artery coverage. Endoleak occurred in three patients (5.9%), resulting in the death of one patient. The remaining two patients had suspected type 4 endoleaks that resolved on follow-up CT. No significant differences were observed in aortic-related mortality and endoleak between the two groups. TEVAR is an effective treatment option for BTAI, even in patients with short proximal sealing zones ≤ 15 mm.

Thoracic stent graft conformability is believed to provide mechanical advantages during thoracic endovascular aortic repair (TEVAR); however, quantitative evidence and associated clinical outcomes remain limited. This study aimed to assess stent graft conformability across varying aortic arch configurations and pathologies, and to evaluate short- and mid-term technical and clinical outcomes. 
A retrospective, single-centre review was conducted of TEVAR procedures performed using the GORE cTAG stent graft over a seven-year period. Pre- and post-deployment anatomical measurements were obtained using Endosize® software to assess conformability across a range of aortic arch morphologies and aortic syndromes. Conformability was defined as a < 10% change in predefined anatomical parameters, including aortic arch angle and proximal landing zone (PLZ) angle. Demographic data, mortality, complications, incidence of bird beaking, and reintervention rates were analysed. 
Of 189 TEVAR procedures performed during the study period, 111 met inclusion criteria and utilised the GORE cTAG stent graft. High conformability was observed following intervention, with 79% of patients demonstrating < 10% change in aortic arch angle and 88% demonstrating < 10% change in PLZ angle. Bird beaking occurred in 10.8% of patients. The overall reintervention rate was 5.4%, with greater angular changes significantly associated with reintervention (p = 0.039). Overall survival rates at 30 days, 1 year, and 5 years were 95%, 86%, and 80%, respectively. 
The GORE cTAG stent graft demonstrates high conformability across diverse aortic arch morphologies and pathologies, which is associated with favourable short- and mid-term technical and clinical outcomes.
Femoral artery access is commonly used in endovascular therapy (EVT) for peripheral artery disease (PAD), but puncture site complications remain a significant concern. Although manual compression is widely applied, assessment of hemostasis is often subjective. Routine ultrasonographic confirmation of hemostasis may provide a more objective evaluation, but its clinical impact has not been fully clarified. The purpose of this study is to investigate the association between ultrasonography-confirmed hemostasis and femoral artery access site complications following EVT for PAD. This single-center retrospective cohort study analysed 1643 femoral artery access sites in patients undergoing EVT for PAD between January 2018 and August 2025. Until December 2019, hemostasis was assessed based on clinical judgement alone, whereas from January 2020 onward, routine ultrasonographic confirmation of hemostasis was implemented as an institutional protocol. Access sites were categorized into an ultrasonography group (n = 1185) and a non-ultrasonography group (n = 458). A 1:1 propensity score matching analysis yielded 429 matched access sites in each group. The primary endpoint was access site bleeding complications, defined as persistent or recurrent bleeding, hematoma formation, or pseudoaneurysm development during or after compression with a pressure bandage. In the matched cohort, ultrasonography-confirmed hemostasis was associated with a significantly lower incidence of bleeding complications when 6 Fr sheaths were used (3.5% vs. 7.7%, p = 0.022). The incidence of pseudoaneurysm formation was also lower in the ultrasonography group with 6 Fr sheaths (0.95% vs. 3.5%, p = 0.029). No significant differences in bleeding complications were observed between groups when 5 Fr or smaller were used. Within the ultrasonography group, bleeding complication rates did not differ between antegrade and retrograde femoral access approaches. Routine ultrasonographic confirmation of femoral artery hemostasis was associated with fewer access site bleeding complications after EVT for PAD, particularly when larger (6 Fr) sheaths were used. Ultrasonographic evaluation may represent a simple and effective strategy to enhance procedural safety in femoral artery EVT.
Acute ischemic stroke (AIS) can be caused by multiple factors, including intracranial large vessel occlusion (LVO), severe stenosis or occlusion of the cervical carotid artery, or both (tandem lesion). The optimal treatment strategy for tandem lesions remains unclear. This single-arm retrospective study aims to measure outcomes for tandem lesion patients who were treated with emergency carotid artery stenting (eCAS) during endovascular treatment (EVT). Patients who underwent EVT including eCAS for AIS with tandem lesions during the period 2015-2023 at our community teaching hospital in Western Europe were analyzed. Primary outcome was modified Rankin Scale (mRS) at 90-day follow up. Secondary outcomes were mortality within 30 days after stroke, symptomatic intracranial bleeding within 30 days after the stroke, major complications, and angiographic scores. Of the 600 patients who were treated with EVT, 64 underwent 65 eCAS procedures. Preprocedural National Institutes of Health Stroke Scale (NIHSS) scores of these 64 patients ranged from 2 to 24 (median 13). Expanded treatment in cerebral infarction (eTICI) scores immediately postprocedural were 0 (n = 1, 1.5%), 2a (n = 6, 9.2%), 2b (n = 31, 47.7%), 2c (n = 6, 9.2%), or 3 (n = 20, 30.8%). In 10.8% (n = 7) of eCAS procedures, complications occurred during the procedure and in 18.5% (n = 12) complications occurred during the follow-up period. In 9.2% (n = 6) of procedures, patients experienced symptomatic intracranial bleeding. Intracranial bleeding was observed more frequently in patients with preprocedural internal carotid artery (ICA) occlusion than stenosis but the difference was not statistically significant. At 90 days follow-up, in 41.5% (n = 27) of eCAS procedures, patients had an mRS score of ≤ 2. Binary logistic regression analysis revealed age and IV thrombolysis as significant predictors for death and age and a pretreatment low NIHSS score for a good functional outcome after 90 days (mRS 0-2). For bleeding complications none of the predictors reached statistical significance. Emergency carotid artery stenting during EVT for tandem lesions appears feasible with acceptable functional outcomes, despite the occurrence of symptomatic intracranial bleeding in 9% of patients. We must however await the results of randomized controlled trials before firm conclusions about the safety of eCAS can be drawn.
To evaluate the geometrical configuration of the BeFlared bridging stent-graft and the early clinical outcomes in fenestrated endovascular aneurysm repair (FEVAR) for complex abdominal and thoracoabdominal aortic aneurysms. This retrospective single-center study included 23 consecutive patients who underwent FEVAR using at least one BeFlared stent-graft between December 2024 and June 2025. Technical and clinical data were collected prospectively. Geometrical analysis of the stent-graft configuration was performed using postoperative computed tomography angiography (CTA) at 1 month. A total of 70 target vessels (TVs) were treated with BeFlared stent-grafts, achieving a 100% technical success rate. No TV-related endoleaks, instability, or reinterventions were observed at 30-day follow-up. Geometric analysis demonstrated a mean protrusion length of 5.27 ± 0.87 mm and a flare ratio of 0.96 ± .03. The mean protrusion length was 5.4 ± .12 mm for renal stent-grafts and 5.1 ± .18 mm for visceral stent-grafts (p = .155). The mean flare ratio was higher in renal stent-grafts (0.97 ± .03) compared to visceral stent-grafts (0.95 ± .03), (p = .045), though both were within optimal ranges. The mean opening flaring angle was 42.3° ± 19.1 for renal stent-grafts and 41.2° ± 19.4 for visceral stent-grafts (p = .809). Early clinical and technical outcomes of the BeFlared stent-graft in FEVAR are promising, with satisfactory procedural performance and favorable geometric configuration. Larger, multicenter studies with longer follow-up are essential to confirm long-term durability and clinical benefit.
The use of a 4-F platform is increasingly used during peripheral arterial interventions, with most of the devices now being compatible with 0.018″ and 0.014″ wires. Unexpected complications/procedural steps during such procedures can require sudden sheath upsize. In this occasion, to maintain the original low-profile guidewire(s), usually positioned across the target lesion(s), can be extremely important. Hereby we describe a technique to safely allow bailout sheath upsizing without losing access to the target lesion(s), which can be applied in a various number of clinical scenarios.
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Diabetes mellitus is strongly associated with peripheral arterial disease and foot ulceration, frequently requiring revascularisation to promote wound healing. Percutaneous transluminal angioplasty (PTA) is widely used for infrapopliteal arterial disease; however, its effectiveness for ulcer healing compared with alternative strategies remains uncertain. To assess the effects of PTA in infrapopliteal arterial disease for diabetic ulcer healing. We conducted a systematic review of randomised controlled trials identified through MEDLINE, Embase, LILACS, CENTRAL, CINAHL, ClinicalTrials.gov, the World Health Organisation International Clinical Trials Registry Platform, and grey literature sources. Study selection and data extraction were performed independently. Risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-analyses were undertaken where appropriate, and certainty of evidence was evaluated. Of 34 542 records screened, six randomised controlled trials (945 total participants) were included. Compared with venous bypass, PTA was associated with a higher likelihood of ulcer healing (risk ratio 1.20; 95% confidence interval 1.07-1.33; p = .0001; low-certainty evidence). No statistically significant differences were observed between revascularisation strategies for mortality or major amputation. Similarly, no significant differences were identified in comparisons of PTA versus drug-coated balloon or drug-coated stent interventions. PTA may be associated with improved arterial ulcer healing compared with venous bypass in patients with diabetes, without clear differences in mortality or amputation rates. However, the certainty of evidence is low, and these findings should be interpreted with caution. Further adequately powered randomised trials are required to clarify the comparative effectiveness of infrapopliteal revascularisation strategies.
Pulmonary artery pseudoaneurysms pose a therapeutic challenge due to their lack of a defined wall, making the choice of endovascular therapy crucial. The added complexity arises from their proximal location, often necessitating endovascular stenting for effective treatment. Our case highlights a successful therapeutic intervention involving stenting and glue embolization to address a sizable proximal pseudoaneurysm in the right pulmonary artery. This approach demonstrates the efficacy of combining these techniques in managing such challenging cases. The utilization of endovascular stenting, coupled with glue embolization, could be a therapeutic option in the context of giant pseudoaneurysms located proximally within the pulmonary artery.
Non-traumatic and non-iatrogenic pseudoaneurysms of the thyrocervical trunk are exceedingly rare. We report a case of a 63-year-old man with esophageal cancer who presented with fever and worsening chronic cough following initiation of induction chemotherapy. Computed tomographic angiography demonstrated a 1.3 cm pseudoaneurysm arising from the thyrocervical trunk. The lesion was successfully occluded by selective endovascular embolization using N-butyl cyanoacrylate (NBCA) liquid embolic, achieving complete occlusion while preserving flow to adjacent branches. The patient recovered uneventfully, and follow-up imaging demonstrated sustained occlusion of the pseudoaneurysm. This case highlights the safety and efficacy of endovascular embolization as a minimally invasive alternative to open surgery for the management of thyrocervical trunk pseudoaneurysms.
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). 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. 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. 4 (Case Report).