Embolization of traumatic and non-traumatic peripheral vascular lesions with Onyx

Abstract

Abstract:Purpose: The aim of our study is to verify the feasibility and the effi cacy of Onyx as embolization agent in the treatment of traumatic and non-traumatic peripheral vascular lesions. Materials and Methods: In the period between September 2006 and March 2012, we treated with Onyx 26 patients (14 males/12 females; age range, 18-85 years old; mean age, 65 years old), 11 of which with traumatic peripheral vascular lesions and 15 with non-traumatic vascular lesions (9 neoplastic hemorrhagic lesions, 3 arteriovenous malformations (AVMs) and 3 aneurysms). Follow-up controls were performed with clinical examination and by multidetector computed tomography (MDCT) imaging 1, 6, and 12 months after the procedure. Results: All peripheral vascular lesions were embolized with Onyx; 3 patients with aneurysms were treated with Onyx associated with endovascular coils. Four elective and 22 emergency embolization procedures were performed. In all patients, we obtained cessation of bleeding and the complete and permanent embolization of all vascular lesions. Conclusions: Onyx is an eff ective and safe embolization agent for peripheral vascular lesions.

Embolization with ethylene vinyl alcohol copolymer (Onyx®) for peripheral hemostatic and non-hemostatic applications: a feasibility and safety study

“…It is categorized as a non-absorbable, non-adhesive, permanent liquid embolic agent that may be used off-label for both small and large vessels (2). These features making EVOH copolymer effective in treating cerebrovascular lesions may benefit peripheral applications, which explain why its use is becoming more widespread among interventional radiologists in the treatment of peripheral lesions (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). However, Onyx  is still perceived by some interventional radiologists as an expensive and complex embolic agent.…”

Single institutional experience of peripheral applications of a liquid embolic agent: Ethylene Vinyl Alcohol Copolymer

“…Being a non-adhesive agent, it allows precise positioning and control of the tip of the delivery microcatheters during the EVOH injections. The Interventionalist can interrupt the injection, reanalyze the EVOH cast and reinject at the new location to occlude a large AVM without filling the draining veins (Regine et al, 2015 ). A prior study has reported reflux of EVOH within the afferent artery during embolization of high flow AVM and nontarget embolization.…”

“…Other rare off-label uses of EVOH include embolization of gastrointestinal hemorrhage (Urbano et al, 2014 ), post-traumatic hemorrhage (Müller-Wille et al, 2011 ), type I endoleaks (Eberhardt et al, 2014 ), pulmonary hemorrhages (Bommart et al, 2011 ; Izaaryene et al, 2016 ), pseudoaneurysms (PSAs) (Vanninen & Manninen, 2007 ), pelvic AVMs (Castaneda et al, 2002 ; Wohlgemuth et al, 2015 ), and neoplasms. (Regine et al, 2015 ) The existing literature is in the form of case reports or series. The possible reasons for the slow adoptation of this agent in the treatment of peripheral pathologies could be secondary to its perceived technical complexity, inadequate training, feared complications, high cost and lack of data demonstrating its efficacy and safety profile.…”

A novel method of inducing thrombosis in target arteries using coronary stents for therapeutic occlusion

“…Bronchial artery embolization (BAE) was first described by Rémy et al in 1973 [ 3 ], and it is now considered a first-line treatment for most cases of massive hemoptysis [ 4 , 5 ]. The technique performed in the above seven cases is a new technique of embolization after deployment of a stent in the bleeding artery.…”