Efficacy and Safety of Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs) in Transcatheter Arterial Embolization (TAE) of Acute Non-Neurovascular Bleeding: A Multicenter Retrospective Cohort Study

Abstract

Background and Objectives: Transcatheter arterial embolization (TAE) is part of the daily practice of most interventional radiologists worldwide. The ideal liquid embolic agent is far from being identified. Non-adhesive liquid embolic agents (NALEA) harden from the outside to the inside, resulting in deep penetration, known as “magma-like” progression, which permits a more distal embolization with good control of the embolic material. This multicenter retrospective cohort study aims to assess the efficacy, feasibility and safety of transcatheter arterial embolization (TAE) with ethylene-vinyl alcohol (EVOH)-based NALEAs (Onyx and Squid) in acute bleeding outside of the neurovascular area. Materials and Methods: This study is a multicenter analysis of retrospectively collected data of consecutive patients who had undergone, from January 2015 to December 2022, transcatheter arterial embolization with non-adhesive EVOH-based agents in the setting of acute non-neurovascular bleeding. Results: Fifty-three patients underwent transcatheter arterial embolization for acute non-neurovascular bleeding. Eight (15.1%) procedures were performed in patients with coagulopathy. The most used concentration of EVOH-based NALEAs was 34 (i.e., 8%), with a mean dose of 0.5 (±0.3) mL. The mean CT-to-groin time, the mean procedure time, the mean CT-to-embolization time and the mean fluoroscopy time were 22.9 (±12.4) min, 27.5 (±7) min, 50.3 (±13.1) min and 7.5 (±2.8) min, respectively. Technical success was achieved in all cases with a 96.2% clinical success rate. Complications were recorded in six (11.3%) patients. No statistically significant differences were observed between the group of patients with coagulopathy and the group of patients without coagulopathy in terms of efficacy and safety endpoints. Conclusions: Transcatheter arterial embolization (TAE) performed with non-adhesive EVOH-based embolic agents is an effective, feasible and safe strategy for the management of acute non-neurovascular bleeding, even in the subgroup of patients with coagulopathy.

Efficacy and Safety of Axiostat® Hemostatic Dressing in Aiding Manual Compression Closure of the Femoral Arterial Access Site in Patients Undergoing Endovascular Treatments: A Preliminary Clinical Experience in Two Centers

“…Postoperative hemostasis maintenance can be indirectly assessed by bleeding-related VASCs, which can serve as surrogate markers [ 18 ]. In our investigation, bleeding-related VASCs were observed in seven (5.8%) cases and VASCs in 10 (8.3%) cases, in keeping with the current literature [ 56 , 57 ]. Therefore, manual compression closure of the femoral arterial access site aided by the Axiostat ® hemostatic dressing proved to be safe in patients undergoing endovascular treatment.…”

Efficacy and Safety of Distal Radial Access for Transcatheter Arterial Chemoembolization (TACE) of the Liver

“…According to both the CTCAE and the CIRSE classification systems, patients experienced a global rate of adverse events after chemoembolization that is comparable to previous data on cTACE, DSM-TACE, or DEB-TACE, performed with conventional femoral or radial accesses [19,20,39,[54][55][56], and on other procedures in the endovascular fields [57][58][59]. Finally, in our investigation, we did not observe significant differences in terms of safety endpoints between the group undergoing DEB-TACE with femoral access and the group undergoing DEB-TACE with distal radial access.…”

Transcatheter Arterial Embolization (TAE) of Cancer-Related Bleeding

“…The embolic agent was administered under fluoroscopic supervision, in accordance with the manufacturer’s instructions. After using a non-adhesive liquid embolic agent (NALEA) or N-butyl cyanoacrylate (NBCA), the microcatheter was never reused or cleansed [ 19 ]. If there was evidence of arterial bleeding on the CTA or endoscopy, subsequently not noticed on angiography, a blind embolization was then conducted.…”

“…( B ) displays a digital subtraction angiography confirming the presence of a ruptured pseudoaneurysm, arising from a feeding artery of the tumor. ( C ) exhibits DSA, illustrating successful embolization, using an EVOH copolymer cast (arrowhead) (from [ 19 ], by MDPI, Basel, Switzerland, licensed under CC BY 4.0).…”