"Lock-and-Advance" Technique: A Triple Co-axial System With a Steerable Microcatheter for Retrograde Embolization of a Ruptured Splenic Artery Aneurysm.

A ruptured splenic artery aneurysm (SAA) is a life-threatening condition requiring urgent endovascular isolation. However, antegrade access can be challenging due to severe tortuosity or anatomical changes post-gastrectomy. An 80-year-old woman presented with a ruptured 45 mm pseudoaneurysm originating from a SAA five days after femoral fracture surgery. Initial antegrade access failed because of a narrowed and tortuous entry to the distal artery. We performed a retrograde trans-collateral approach via the transverse pancreatic artery. A triple co-axial system was used, featuring a 2.9-Fr steerable microcatheter (Leonis Mova HF; Sumitomo Bakelite, Tokyo, Japan), a 1.9-Fr microcatheter (Carnelian MARVEL; Tokai Medical Products, Aichi, Japan), and a 0.010-inch guidewire (CHIKAI X010; ASAHI INTECC, Tokyo, Japan). By locking the steerable microcatheter at curvatures to enhance backup support, the inner system successfully navigated the tortuous collaterals to achieve distal embolization. The "lock-and-advance" technique using a steerable microcatheter may be a feasible and useful option for navigating delicate collateral pathways in emergency settings.