Transosseous Arterial Embolization during Percutaneous Sclerotherapy of a Sacral Aneurysmal Bone Cyst in a Pediatric Patient

Background Aneurysmal bone cysts (ABCs) of the sacrum are uncommon, technically challenging lesions located near critical neurovascular structures. Both percutaneous sclerotherapy and transarterial embolization are established treatment options. However, inadvertent vascular access during transosseous needle placement is exceedingly rare. Case presentation: We report a case of a 15-year-old girl undergoing planned transosseous doxycycline sclerotherapy of a sacral ABC, during which arterial blood return occurred. Angiography confirmed accidental puncture of the distal left iliolumbar artery—the planned target for subsequent embolization. The transosseous route was successfully used for selective embolization using Squid-34 and a microcoil, avoiding the need for separate femoral arterial access. Sclerotherapy was then completed as planned. The patient recovered well and demonstrated clinical and radiologic stability at six-month follow-up. Conclusion This case highlights the importance of real-time procedural adaptability in interventional radiology and demonstrates that inadvertent transosseous vascular access can be safely utilized for therapeutic embolization when aligned with procedural goals.