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

Ne, Romaric; Chevallier, Olivier; Falvo, Nicolas; Facy, Olivier; Berthod, Pierre-Emmanuel; Galland, Christophe; Gehin, Sophie; Midulla, Marco; Loffroy, Romaric

doi:10.21037/qims.2018.04.03

Cited by 31 publications

(38 citation statements)

References 22 publications

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“…In the past, different embolic agents were used for PVE, even though cyanoacrylate glue is usually considered the ideal embolic agent with the highest expected rate of liver regeneration (Jaberi et al, 2016). Onyx was previously used in PVE either in humans (Né et al, 2018) or in experimental models (Smits et al, 2012). In our series, Squid and PVA particles (coils in some cases) were used as embolic agents in PVE obtaining good outcomes in terms of technical success (100%), clinical success (80%), and also future liver remnant volume increase (more than 50%).…”

Section: Discussionmentioning

confidence: 99%

“…Using non adhesive liquid embolic agents composed of EVOH copolymer dissolved in dimethyl sulfoxide (DMSO) and mixed with micronized tantalum powder, as Onyx, it is possible to obtain a slower solidification, a more prolonged injection time and a reduced risk of microcatheter entrapment than n-BCA. Onyx, first described in 1990s, represents the well-known liquid embolic agent widely used in cerebral arteriovenous malformations (AVMs) (Gemmete et al, 2009;Singfer et al, 2017;Alturki et al, 2018;Nerva et al, 2018) and also in abdominal-peripheral applications (Cobb et al, 2014;Né et al, 2018;Izaaryene et al, 2016;Regine et al, 2015;Chevallier et al, 2016), particularly in the management of endoleak post Endovascular Aortic Repair (EVAR) (Marcelin et al, 2017;Ierardi et al, 2018). Squid is a new DMSO-and EVOH-based liquid embolic agent which has mainly been used in cerebral field (Akmangit et al, 2017;Gioppo et al, 2017) with poor application in abdominal district (Szatmáry et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Background: Squid, as Onyx, is an ethylene-vinyl alcohol copolymer (EVOH)-based liquid embolic agent developed for neuroradiologic interventions with poor application in abdominal district. Our aim was to evaluate safety, complications, and efficacy of transcatheter embolization using the two available formulations Squid-18 and 12, in 30 patients affected by different abdominal diseases. Results: Transcatheter embolization with Squid, combined with other embolic agents, as poly vinyl alcohol (PVA) particles, coils and amplatzer plugs, or alone (type 2 endoleak), was performed in 30 patients, as follows: 10 portal vein embolizations (PVEs), 6 arteriovenous malformations (AVMs), 5 visceral artery aneurysms (VAAs), 4 type 2 endoleaks, 3 preoperative embolizations, 1 acute arterial bleeding, 1 female varicocele. Squid was always administered using dimethyl sulfoxide (DMSO) compatible microcatheters. Technical success, 30-day clinical success and complications were assessed. Technical success was 90%. 3 patients (2 AVMs, 1 VAA) required re-intervention successfully performed in all cases. Major complications, cases of microcatheter entrapment and DMSO-related poor pain control were not recorded. 30-day clinical success was 93.3%: in 2 patients submitted to PVE a sufficient future liver remnant (FLR) hypertrophy was not achieved. Conclusion:Squid was successfully used with low complication rate in many abdominal diseases showing a valid embolic action either combined with other embolic agents or alone in type 2 endoleak. The availability of different formulations (Squid-18 and Squid-12) variable for viscosity makes Squid preferable to Onyx as EVOH-based liquid embolic agent, even though comparable studies in different abdominal districts with a larger cohort of patients will be necessary.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…All targeted portal branches were successfully embolized without any occurrence of nontarget embolization. An evident drawback of using EVOH is the elevated price of this product and the necessity of large amount of vials with a mean of 12.3 vials per procedure [60], Tables 1 and 2.…”

Section: Ethylene Vinyl Alcohol (Evoh) Copolymermentioning

confidence: 99%

Preoperative Portal Vein Embolization in Hepatic Surgery: A Review about the Embolic Materials and Their Effects on Liver Regeneration and Outcome

Luz

Gomes

Coimbra

et al. 2020

Radiology Research and Practice

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Liver volume and function after hepatectomies are directly correlated to postoperative complications and mortality. Consequently contemporary liver surgery has focused on reaching an adequate future liver remnant so as to diminish postoperative morbidity and mortality. Portal vein embolization has evolved and is the standard of care as a liver regenerative strategy in many surgery departments worldwide before major liver resections. Different embolic materials have been used for portal vein embolization including gelfoam, ethanol, polyvinyl-alcohol particles, calibrated microspheres, central vascular plugs, coils, n-butyl-cyanoacrylate glue, fibrin glue, polidocanol-foam, alcoholic prolamin solution, and ethylene vinyl alcohol copolymer, as sole occluders or in varied combinations. While to date there has been no prospective controlled trial comparing the efficacy of different embolic materials in portal vein embolization, retrospective data insinuates that the use of n-butyl-cyanoacrylate and absolute ethanol produces higher contralateral liver hypertrophies. In this review, we evaluated publications up to August 2019 to assess the technical and regenerative results of portal vein embolization accomplished with different embolic materials. Special attention was given to specific aspects, advantages, and drawbacks of each embolic agent used for portal vein embolization, its liver regenerative performance, and its influence on patient outcome.

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“…This embolic agent, commercially available as Onyx, rapidly solidifies as the water soluble DMSO diffuses out upon coming in contact with physiological fluids. Additional applications of this system include the embolization of liver tumors, carotid paragangliomas and intracranial dural arteriovenous fistulas as well as the prevention of aneurismal Endoleaks Type II and other embolic uses …”

Section: Chemical Phenomenamentioning

confidence: 99%

In Situ Generated Medical Devices

Cohn

Sloutski

Elyashiv

et al. 2019

Adv Healthcare Materials

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Medical devices play a major role in all areas of modern medicine, largely contributing to the success of clinical procedures and to the health of patients worldwide. They span from simple commodity products such as gauzes and catheters, to highly advanced implants, e.g., heart valves and vascular grafts. In situ generated devices are an important family of devices that are formed at their site of clinical function that have distinct advantages. Among them, since they are formed within the body, they only require minimally invasive procedures, avoiding the pain and risks associated with open surgery. These devices also display enhanced conformability to local tissues and can reach sites that otherwise are inaccessible. This review aims at shedding light on the unique features of in situ generated devices and to underscore leading trends in the field, as they are reflected by key developments recently in the field over the last several years. Since the uniqueness of these devices stems from their in situ generation, the way they are formed is crucial. It is because of this fact that in this review, the medical devices are classified depending on whether their in situ generation entails chemical or physical phenomena.

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

Abstract: Transcatheter embolization with Onyx is feasible and safe in the peripheral arterial or venous vasculature for both bleeding and non-bleeding patients whatever the anatomic site.

Cited by 31 publications

References 22 publications

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

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

Preoperative Portal Vein Embolization in Hepatic Surgery: A Review about the Embolic Materials and Their Effects on Liver Regeneration and Outcome

In Situ Generated Medical Devices

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