Fig. 2

Images from a 60-year-old man with left OA bleeding associated with SAM. a Coronal volume-rendered computed tomography image in cranial and right-anterior projection reveals that a left OA (white arrows) arises acutely from a splenic artery branch and develops subtle dilation and stenotic change. The distal side of left OA is completely occluded (white arrowhead), presumably associated with SAM. Note that right gastroepiploic artery (black arrowheads) courses alongside the greater curvature of and one of the right omental branches off vertically (black arrows), which is found to be directly communicated with the to-be embolized left OA (white arrows). SAM is the most likely diagnosis, and transarterial embolization is planned. b DSA of left OA in right anterior oblique projection reveals that it acutely arises from a splenic artery and that it develops the dilation and stenotic change (dotted circle) and complete occlusion (arrow). Given that embolization of the proximal left OA at the arrow-indicating point could lead to incomplete hemostasis or rebleeding via arterial collateral network through another OA arising from right gastroepiploic artery, attempt was made to navigate the microcatheter into the distal side beyond the occluded point without complications. c DSA of the distal side of left OA in posteroanterior projection reveals that distal left OA does not develop findings suggestive of SAM. Note that the to-be-embolized left OA directly communicates with a right OA arising from right gastroepiploic artery (arrows). Embolization was successfully performed using isolation technique with coils. d DSA of gastroduodenal artery in posteroanterior projection reveals a right OA (arrows) directly communicating with the embolized left OA, which does not develop any further a potential bleeding point. Note that the SAM-associated left OA (dotted circle) is embolized with metallic coils. Complete hemostasis by isolation technique with coils is confirmed