Fig. 1

A Contrast media was injected through the access sheath transsplenic tract and intraparenchymal splenic vein branch in the patient while the access sheath was pulled backwards (red arrow) until a parenchymal tract is visible. Then, a gelfoam plug (gray) was loaded in the tip of a second sheath, the insertion sheath (green arrow). Of note, two dilators were shown in this image (blue). One dilator was shortened concisely to the end of the sheath with an incision scalpel, the insertion dilator. B Then, the tip of the gelfoam-loaded insertion sheath was introduced through the membrane of the access sheath in the splenic tract (both sheaths were the same size). C Pushing the normal length dilator into the insertion sheath (red arrow), we transferred the gelfoam plug in the access sheath. D After successful transfer of the gelfoam plug in the access sheath, the insertion sheath and the normal length dilator were removed. The insertion dilator was introduced in the access sheath to advance the gelfoam plug. E The insertion dilator is almost loaded in the access sheath. F Finally, the access sheath is gently pulled backward (red arrow) while the insertion dilator is held in position to release the gelfoam plug in the tract (“withdrawal technique”)