Endovascular management of splenic artery aneurysm with arteriovenous fistula using dual microcatheter embolization

Splenic artery aneurysm with arteriovenous fistula is rare and technically challenging, particularly in the setting of marked tortuosity and high-flow shunting. We report the case of a 69-year-old woman treated with a fully endovascular approach guided by intraoperative cone-beam computed tomography. A dual microcatheter technique enabled targeted deployment of detachable coils followed by Onyx embolization, achieving complete fistula occlusion while preserving collateral splenic perfusion through short gastric arteries. The procedure was completed without complications, and the patient was discharged the following day. Advanced endovascular techniques offer a safe and effective alternative for complex visceral vascular pathology.