Transarterial embolization of acute non-neurologic bleeding using Ethylene Vynil Alcohol Copolymer: a single-Centre retrospective study

Abstract

Background To evaluate feasibility, safety and effectiveness of transarterial embolization of acute non-neurologic hemorrhage with Ethylene Vynil Alcohol Copolymer (EVOH). Methods Between January 2018 and June 2021, 211 patients (male 123, mean age 69.7 y + 17.9) who underwent transarterial embolization with Onyx™ for acute non-neurologic arterial bleeding were retrospectively reviewed. Most frequent etiology of bleeding was post-operative (89/211, 42.2%), trauma (62/211, 29.4%) and tumor (18/211, 8.5%). Technical success was defined as the angiographic evidence of target vessel complete occlusion. Clinical success was defined as resolution of bleeding. Any rebleeding within the primitive site, requiring a new intervention during the first 30-days following embolization, was considered a clinical failure. Occurrence of procedure-related complication and mortality within 30 days of the embolization were examined. Results A total of 229 embolization procedures was performed in 211 pts.; technical success rate was 99.5% (210/211 pts). Clinical success rate was 94.3% (199/211 pts). In 11 patients (5.2%) a reintervention was needed because of a rebleeding occurring within the primitive site, whereas in five patients (2.4%) rebleeding occurred within a site different from the primitive. Factors more often associated with clinical failure were coagulopathy/ongoing anticoagulant therapy (5/11, 45.4%), and post-operative etiology (3/11, 27.3%). EVOH was used as the sole embolic agent in 214/229 procedures (93.4%), in association with coils in 11 cases (4.8%), and with microparticles in 4 cases (1.7%). In the present series, major complications occurred in 6 cases (2.8%): respectively, four cases (1.9%) of colonic ischemia and two groin hematomas (0.9%) with active extravasation were observed. 26 (12.3%) patients died during the follow-up. Conclusion Embolization of acute arterial bleeding with EVOH as a first-line embolic agent is feasible, safe and effective.

Acute Nonvariceal Gastrointestinal Bleeding: A Comprehensive Review and Approach for an Interventional Radiologist

“…Choice and selection of appropriate embolic agents is of paramount importance since it depends on various factors like need of permanent or temporary embolization, chances of rebleeding, visceral ischemia, desired level of embolization, etiology of GIB, radiologist's experience, availability of embolic materials, and site and size of the bleeding artery. [35][36][37] A wide range of embolic materials are available commercially; however, the selection and choice of different embolic materials do not have any consensus/guidelines and are still debatable. The possible reason may be attributed to variable safety profile and delivery techniques.…”

“…[38][39][40][41] However, recanalization of a vessel after gelfoam embolization may happen within days to weeks, which also remains a concern for rebleeding. 36,[42][43][44] GI tumors with profuse surface bleeding may be appropriate candidates for gelfoam embolization if surgery is contemplated within 24 to 48 hours of the procedure. [45][46][47][48] Metallic coils and polyvinyl alcohol particles (PVA) are the most commonly used permanent embolic agents of choice in GIB.…”

“…35 The data on rebleeding rate after onyx embolization is limited and the available published meta-analysis has reported approximately 7.6% rebleeding rate. 36 Liquid sclerosant is not widedly used in GIB. These agents are commonly used for variceal bleeding with endospoic sclerotherapy.…”

“…Vascular etiologies like arteriovenous malformation need closure of nidus by liquid agents. [35][36][37] Desired levels of arterial anatomical embolization and their selective embolic agent of the first choice have been shown in the illustration (►Fig. 13).…”