Outcomes of Onyx® Embolization of Type II Endoleaks After Endovascular Repair of Abdominal Aortic Aneurysms

Mozes, Gergely; Pather, Keouna; Oderich, Gustavo S.; Mirza, Aleem K.; Colglazier, Jill J.; Shuja, Fahad; Mendes, Bernardo C.; Kalra, Manju; Bjarnason, Haraldur; Bower, Thomas C.; Huang, Ying; Gloviczki, Péter; DeMartino, Randall R.

doi:10.1016/j.avsg.2020.02.013

Cited by 14 publications

(29 citation statements)

References 16 publications

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“…However, the definition of clinical success was not uniform and included the lack of evidence of a residual endoleak and/or the detection of a stable or regressive aneurysm diameter on follow-up CT imaging [24]. Similar clinical success rates for T2EL were also found in later studies with EVOH being used alone or in combination with coils [17,26,27,43]. On a retrospective basis, technically incomplete embolization of T2ELs with EVOH does not necessarily rule out clinical success [26].…”

Section: Technical and Clinical Results Achieved With Evohmentioning

confidence: 98%

“…The goal of T2EL treatment is to stop flow within the endoleak cavity and to relieve pressure in the aneurysm sac. For technical success of the intervention, the embolization endpoint includes filling of the nidus with an embolic agent with all involved branches ideally being blocked [17,26,27]. Clinical success has been achieved when the aneurysm remains stable or shrinks in postinterventional follow-up.…”

Section: Intervention Objectivementioning

confidence: 99%

“…EVOH can be used as a single embolic agent [26] or in combination with coils [41,42]. It must be taken into consideration that coils can no longer pass through the microcatheter after contact with EVOH.…”

Section: Application Of Evoh In T2elmentioning

confidence: 99%

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Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer

Nolte-Ernsting¹,

Mecklenbeck²,

Stehr³

2021

Rofo

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Background Type 2 endoleaks (T2EL) are the most frequent complication following endovascular aortic repair. Multiple studies primarily deal with the technical and clinical success of the embolization of persisting T2EL, thereby revealing controversial outcomes. Current reports rarely focus on the detailed execution of such a complex interventional procedure with respect to the difficult anatomic setting. Methods The present review provides an in-depth depiction and evaluation of the interventional methodology of the embolization of T2EL in the abdominal aorta with use of ethylene vinyl alcohol copolymer (EVOH). Complicating anatomic conditions are taken into account as well as technical and clinical success rates. Results Using the transarterial approach, there are at least 4 different pathways to access the nidus of a T2EL. CT-guided direct puncture of the aneurysm sac provides an alternative method of high technical success. EVOH with its slow solidification characteristics enables good control to achieve complete filling of the T2EL. During the intervention, however, it remains difficult to meet exactly the embolization endpoint, especially in large T2ELs. Conclusion T2EL embolization using EVOH is an effective treatment with low major complication rates when conducted by skilled interventionists with detailed knowledge of diverse complex access routes. Key Points: Citation Format

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Section: Technical and Clinical Results Achieved With Evohmentioning

confidence: 98%

Section: Intervention Objectivementioning

confidence: 99%

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Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer

Nolte-Ernsting¹,

Mecklenbeck²,

Stehr³

2021

Rofo

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“…In the past, non-adhesive liquid embolic agents have been widely used in intracranial district for cerebral aneurysms [ 61 ], but rarely in abdominal district for VAAs [ 62 ]. Nowadays, ethylene vinyl alcohol copolymer (EVOH) agents, well-known as Onyx (Medtronic, Dublin, Ireland), Squid (Emboflu, Gland, Switzerland) and Phil (Precipitating Hydrophobic Injectable Liquid, MicroVention, Terumo, Austin, USA), are routinely used in many abdominal diseases [ 63 , 64 , 65 , 66 , 67 ] and also in splenic [ 68 ], hepatic [ 69 ], mesenteric [ 70 ] and renal aneurysms [ 71 ]. These liquid embolic agents are EVOH copolymers mixed with micronized tantalum powder and dissolved in dimethyl sulfoxide (DMSO).…”

Section: Embolization: Techniques and Materialsmentioning

confidence: 99%

Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives

Venturini

Piacentino

Coppola

et al. 2021

JCM

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Visceral artery aneurysms (VAAs) are rare, usually asymptomatic and incidentally discovered during a routine radiological examination. Shared guidelines suggest their treatment in the following conditions: VAAs with diameter larger than 2 cm, or 3 times exceeding the target artery; VAAs with a progressive growth of at least 0.5 cm per year; symptomatic or ruptured VAAs. Endovascular treatment, less burdened by morbidity and mortality than surgery, is generally the preferred option. Selection of the best strategy depends on the visceral artery involved, aneurysm characteristics, the clinical scenario and the operator’s experience. Tortuosity of VAAs almost always makes embolization the only technically feasible option. The present narrative review reports state of the art and new perspectives on the main endovascular and other interventional options in the treatment of VAAs. Embolization techniques and materials, use of covered and flow-diverting stents and percutaneous approaches are accurately analyzed based on the current literature. Visceral artery-related considerations and targeted approaches are also provided and discussed.

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“…Endoleaks remain one of the most frequent indications for secondary interventions after endovascular aneurysm repair (EVAR) and fenestrated-branched EVAR. [1][2][3] The reported incidence of sac enlargement after EVAR ranges from 0.2% to 41%, mostly due to an identifiable endoleak. 4 Computed tomography angiography (CTA) with delayed phase is typically the imaging modality of choice, but magnetic resonance angiography and contrast-enhanced duplex ultrasound (CEUS) have high sensitivity to detect small endoleaks.…”

mentioning

confidence: 99%

Total realignment of multibranch stent graft using redo branch-in-branch endovascular repair for occult endoleak with rapid aneurysm sac expansion

Mirza¹,

Tenorio²,

Macedo³

et al. 2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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Occult endoleaks can pose a diagnostic and treatment challenge. These endoleaks are not effectively identified by multiphase computed tomography angiography, magnetic resonance angiography, or contrast-enhanced ultrasound. Possible causes are small fabric tears and slow-flow, dynamic, or positional endoleaks. We describe a patient with rapid aneurysm sac expansion and disseminated intravascular coagulopathy 46 months after four-vessel branched physicianmodified endograft repair of a ruptured extent III thoracoabdominal aneurysm. Imaging failed to demonstrate an endoleak but identified fresh blood products within the sac. The patient underwent total realignment using branch-inbranch repair with a physician-modified endograft. Repeated imaging 25 days postoperatively revealed decrease in aneurysm diameter by 10 mm.

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Outcomes of Onyx® Embolization of Type II Endoleaks After Endovascular Repair of Abdominal Aortic Aneurysms

Cited by 14 publications

References 16 publications

Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer

Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer

Visceral Artery Aneurysms Embolization and Other Interventional Options: State of the Art and New Perspectives

Total realignment of multibranch stent graft using redo branch-in-branch endovascular repair for occult endoleak with rapid aneurysm sac expansion

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