Marked tortuosity of the splenic artery is a common challenge faced during splenic artery embolization and may result in technical failure of the procedure. We report an alternative novel approach that involves catheterization of the distal splenic artery through gastric collaterals. The technique is an alternative when the standard approach is not feasible.

From the manuscript

Treatment of Hypersplenism by Partial Splenic Embolization Through Gastric Collaterals

Abstract
We report a case of Chronic lymphocytic leukemia (CLL) with associated hypersplenism, that was referred to us for partial splenic embolization (PSE) as the patient was not a surgical candidate for splenectomy. Initially, we were not successful in catheterizing the splenic artery from the celiac trunk due to significant atherosclerotic disease. Therefore, we successfully managed to access the distal splenic artery through patent gastro-epiploic collateral circulation along the greater curvature of the stomach. Partial splenic embolization was successfully performed and resulted in improvement of the patient`s peripheral blood cell count as well as 60-70% reduction in the size of the spleen on follow up. Our case highlights an alternative pathway for splenic artery embolization when catheterization of the splenic artery is not feasible. To our knowledge, the use of gastro-epiploic collaterals to embolize the spleen has not been previously reported in literature.