Thinking beyond conventional routes: Percutaneous transabdominal glue embolization of a small-bowel collateral vein

Abstract

Small-bowel wall venous collaterals are uncommon vascular entities and may present technical challenges for conventional endovascular management. Image-guided percutaneous embolization provides a minimally invasive alternative when standard vascular access is not feasible.

We report a case of complex abdominal venous collateralization identified on contrast-enhanced CT. Imaging demonstrated a long collateral vessel arising from the superior mesenteric vein, extending anteroinferiorly and coursing through the lower anterior abdominal wall before draining into the bilateral common femoral veins through multiple collateral channels. During its course, the vessel traversed the wall of a small-bowel loop and partially extended into a hernial sac.

Under ultrasound and fluoroscopic guidance, the collateral vein was accessed via a percutaneous transabdominal approach. Embolization was performed using Glubran mixed with Lipiodol with dilution adjusted according to flow dynamics. Immediate on-table Dyna CT confirmed precise glue deposition within the targeted venous segment.

Post-procedure Doppler ultrasound demonstrated complete occlusion without residual flow and no immediate complications.