Figure 3

a) Axial CT of a 73 year old man with iatrogenic splenic injury following chest drain insertion. An active bleeding point in the spleen (arrow) with surrounding haematoma was demonstrated. b) Coronal CT reconstruction showing a tortuous splenic artery and bleeding point (arrow). These allowed optimal catheter choice for arteriography. c) A Tracker-18 microcatheter system with a Fasdasher 0.014 in wire (Boston Scientific, Maple Grove, MN, USA) were used to achieve access distally within the splenic circulation. After several unsuccessful attempts at superselective catheterisation of the branch supplying the bleeding point, 4 platinum Vortex-18 diamond-shaped coils (Boston Scientific) were deployed sequentially in the main splenic artery distal to the dorsal pancreatic branch. 2 initial coils migrated past the required branch and there is ongoing bleeding from the spleen (arrow). d) The next 2 coils achieved occlusion of the main splenic artery with preservation of branches to the dorsal pancreas and upper pole of the spleen. e) Axial CT at 1 week showed a small splenic infarct where the initial coils had migrated distally. Arterial supply to the spleen was preserved with some flow through the main splenic artery coils.