To present our experience and provide a literature review dissertation about the use of a suture-mediated percutaneous closure device (Perclose Proglide -PP- Abbott Vascular Inc., Santa Clara, CA, USA) to achieve hemostasis for unintended subclavian arterial catheterization during central venous line placement. Since October 2020, we have successfully treated four consecutive patients with a central venous catheter (8 to 12 French) in the subclavian artery. In each patient, we released a PP, monitoring its efficacy by performing a subclavian angiogram and placing, as a rescue strategy, an 8 mm balloon catheter near the entry point of the misplaced catheter. Primary outcome is technical and clinical success. Technical success is defined as absence of bleeding signs at completion angiography, while clinical success is a composite endpoint defined as absence of hematoma, hemoglobin loss at 12 and 24 h, and absence of procedure-related reintervention (due to vessel stenosis, pseudoaneurysm or distal embolization). Technical success was obtained in 75% of cases. In one patient a mild extravasation was resolved after 3 min of balloon catheter inflation. No early complications were observed for all patients. PP showed a safe and effective therapeutic option in case of unintentional arterial cannulation. It can be considered as first-line strategy, as it does not preclude the possibility to use other endovascular approaches in case of vascular closure device failure.

Background: Splenic artery embolization (SAE) has emerged as a key adjunct to non-operative management (NOM) in hemodynamically stable patients with blunt splenic trauma, yet variability in its application persists across centers. Objectives: The aim was to evaluate real-life clinical practices, techniques, and outcomes of SAE in blunt splenic trauma across multiple Italian trauma centers. Materials and Methods: This retrospective multicenter study analyzed data from 281 patients undergoing emergency SAE for blunt splenic trauma between January 2019 and December 2021. Demographics, imaging findings, embolization techniques, complications, and outcomes were collected and analyzed. Multivariate logistic regression was used to assess predictors of splenectomy. Results: The technical success rate was 100%, with a 9.6% rate of post-embolization splenectomy and a complication rate of 24.9% (including 5.7% splenic infarction and 3.2% rebleeding). Embolization was performed proximally (46.6%), distally (28.8%), or with a combined approach (24.6%). No significant correlation was found between embolization technique and splenectomy rate. Patients with AAST grade III injuries benefited from SAE with high technical success and low failure rates. Notably, 14.2% of patients underwent angiography despite negative CT, with a splenectomy rate of 10% in this subgroup. Multivariate analysis identified no independent predictors of splenectomy. Conclusions: SAE is a reliable and effective tool in the management of blunt splenic trauma, achieving high splenic salvage rates even in selected grade III injuries and CT-negative patients. In an era of precision medicine, interventional radiology should be regarded as a distinct and specific treatment modality, comparable to surgery, rather than being merely included within non-operative management (NOM).

Purpose: Through a paradigmatic case and a systematic literature review, we present various endovascular strategies for treating pelvic paravesical arteriovenous vascular malformations (AVMs), with a focus on the efficacy of accessing the shunt point through direct puncture of the venous collector. Case Report: A 42-year-old male with nonspecific pelvic pain underwent a computed tomography (CT) scan, which revealed bilateral pelvic AVMs characterized by a network of arteriolar afferents originating from the internal iliac arteries and the inferior mesenteric artery, draining into 2 interconnected giant venous sacs in the bilateral paravesical space. The malformation was classified as type II according to the Cho classification. Following an unsuccessful attempt at transarterial embolization, we devised a plan for bilateral transvenous embolization in 2 separate sessions. Venous access was achieved through percutaneous transperineal ultrasound-guided puncture of the dominant outflow venous sac. A microcatheter was then placed directly into the shunt point, where sclerosant and embolic agents were specifically delivered. Follow-up imaging showed complete obliteration of both pelvic AVMs. Conclusions: Effective hemostasis of pelvic paravesical AVMs can be achieved by targeting the shunt point from the aneurysmal dominant outflow vein, potentially through direct percutaneous puncture. Clinical Impact: This study aims to demonstrate the effectiveness of a transvenous approach in cases of embolization of pelvic paravesical arteriovenous vascular malformations (AVMs). The key to successful treatment lies in occluding the shunt point within the aneurysmal dominant outflow vein’s wall, which can be reached transvenously and potentially through direct percutaneous puncture. Although arterial occlusion can be performed additionally, it should not be performed alone due to its higher risk of AVM persistence/recurrence.