Background and Objectives: Treatment of visceral artery pseudoaneurysms (VAPs) is always
indicated regardless of their diameters, as their risk of rupture is significantly higher than that of
visceral artery aneurysms. The invasiveness of surgery and its associated complications have led
to a shift in favor of radiological interventions as the initial treatment of choice. However, there
are still some unanswered questions on endovascular treatment of VAPs regarding the optimal
endovascular technique and the efficacy and safety outcomes. The purpose of this multicenter
study was to retrospectively evaluate the effectiveness and safety of endovascular treatment of
visceral pseudoaneurysms using Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive
Liquid Embolic Agents (NALEAs). Materials and Methods: Consecutive patients who underwent
endovascular embolization with EVOH-based NALEAs for visceral artery pseudoaneurysms between
January 2018 and June 2023 were retrospectively evaluated. Results: 38 embolizations were performed.
Technical success was achieved in all patients. The clinical success rate was high (92.1% overall),
with no significant differences between ruptured and unruptured VAPs (p = 0.679). Seven patients
(18.4%) experienced procedure-related complications, related to one case of non-target embolization,
four splenic abscesses due to end-organ infarction, and two femoral pseudoaneurysms. The rates of
procedure-related complications, end-organ infarction, and vascular access-site complications did
not significantly differ between ruptured and unruptured VAPs (p > 0.05). Conclusions: Both ruptured
and unruptured visceral pseudoaneurysms can be effectively and safely treated with NALEA-based
endovascular embolization. We suggest considering the use of NALEAs, particularly in specific
clinical cases that highlight their advantages, including patients with coagulopathy, fragile vessels,
and embolization targets that are located at a considerable distance from the microcatheter tip and
are otherwise difficult to reach
