Triple-catheter adjunctive technique through a 6-Fr distal access catheter for coil embolisation of splenic aneurysm: one balloon and two embolisation catheters via single access

We present a novel triple-catheter adjunctive technique through a 6-Fr distal access catheter (DAC) for coil embolisation of an 18 mm wide-necked splenic aneurysm located at the bifurcation of the superior and inferior branches in a 63-year-old female. Despite the significantly tortuous splenic artery, the DAC was successfully navigated near the aneurysm, providing catheter stability. One 2.8-Fr balloon catheter and two 2.2-Fr microcatheters were deployed simultaneously through the DAC to perform the balloon-assisted double-catheter technique. Dense packing was achieved with a volume embolisation ratio of 39.2%, while preserving the superior branch flow. Post-embolisation angiography revealed complete aneurysmal occlusion without splenic infarction. This technique presents a viable solution for complex visceral aneurysms in tortuous anatomies, enabling dense packing while preserving the parent artery, without requiring multiple access sites or larger guiding catheters.