Ethylene–vinyl alcohol copolymer as embolic agent for treatment of type II endoleak: our experience

Abstract

Onyx could be an ideal embolic agent for endovascular and percutaneous embolization of T2 EL.

Transcatheter embolization with Squid, combined with other embolic agents or alone, in different abdominal diseases: a single-center experience in 30 patients

“…Squid alone was used in 4 cases of type II endoleak embolization: after the advancement of a coaxial microcatheter in the Riolano arch or in the ileo-lumbar artery and its placement in the endoleak sac, the progressive filling with Squid of the aneurysmatic sac was successfully performed and a permanent occlusion was obtained. In the past, type 2 endoleak embolization was performed using different embolic agents such as glue, coils, thrombin and Onyx, combined or alone (Abullarage et al, 2012;Ierardi et al, 2017;Khaja et al, 2014). The advantage of using an EVOH-based liquid embolic agent, as Onyx or Squid, is related to its capacity to fill completely the sac including inflow and outflow vessels, forming a more stable plug than that provided by coils (Ierardi et al, 2017).…”

“…In the past, type 2 endoleak embolization was performed using different embolic agents such as glue, coils, thrombin and Onyx, combined or alone (Abullarage et al, 2012;Ierardi et al, 2017;Khaja et al, 2014). The advantage of using an EVOH-based liquid embolic agent, as Onyx or Squid, is related to its capacity to fill completely the sac including inflow and outflow vessels, forming a more stable plug than that provided by coils (Ierardi et al, 2017). Another significant advantage of EVOH-based liquid embolic agents is their complete detachment from the microcatheter tip, not always verifiable after glue infusion.…”

Operative Management of Type II Endoleaks After Aortic Endovascular Repair

“…They are defined as persistent flow within the excluded aneurysm sac and the graft [1][2][3][4]. Endoleaks are classified according to the underlying etiology and localization [5,6]. The risk of rupture of the aneurysmatic sac depends on the type and persistency of endoleaks.…”

“…T2EL occurs when a retrograde flow of blood supplies the aneurysm sac through branch vessels such as lumbar arteries or a patent inferior mesenteric artery (IMA) [4]. T2EL usually has a complex architecture because it should be featured by more than one inflow and outflow vessel, which communicates through a channel [5]. For this reason, a further differentiation of T2EL was proposed: type IIA, when it is related to only one patent branch, and type IIB, when it is complex with two or more patent branches and creating a flow-through situation [4].…”

“…In the past, T2EL were usually treated surgically, both with graft explantation and with retroperitoneal ligation of collateral feeding vessels [5]. These invasive methods require hospital admission and they increase morbidity of surgery [11].…”