Transcatheter Embolisation of Type 1 Endoleaks after Endovascular Aortic Aneurysm Repair with Onyx: When No Other Treatment Option is Feasible

Abstract

Type 1 endoleaks following endovascular aortic aneurysm repair are associated with poor outcomes and re-intervention is recommended as soon as possible after diagnosis. When standard endovascular or surgical treatment options are unsuitable due to severe co-morbidity or adverse anatomic factors, patients can be treated by transcatheter embolisation of the endoleak itself. We describe six such patients with proximal and distal type 1 endoleaks, who have been successfully treated by transcatheter embolisation with Onyx. The embolisation technique, advantages of using this relatively novel liquid embolic agent and potential pitfalls are discussed.

Transcatheter Embolisation of Proximal Type 1 Endoleaks Following Endovascular Aneurysm Sealing (EVAS) Using the Nellix Device: Technique and Outcomes

“…The literature on the management of EL1a following conventional EVAR is very limited. Our published experience of embolisation of six type 1 endoleaks, four of which were proximal endoleaks showed 100 % technical success with Onyx embolisation and no recurrent endoleaks at up to 10 months follow-up [9]. There are few other short reports on type 1 endoleak embolisation with Onyx, together comprising 15 patients [6,[10][11][12].…”

Embolisation of a Proximal Type I Endoleak Post-Nellix Aortic Aneurysm Repair Complicated by Reflux of Onyx into the Nellix Endograft Limb

“…An alternative approach is transcatheter embolisation with Onyx, which is well established for type 2 endoleaks [4]. The use of Onyx for type 1 endoleaks was first described in 2010 [5]; and has since been reported in several short reports [6][7][8][9]. Together these reports comprise 21 cases, 6 performed by our unit, with none reporting Onyx reflux or non-target embolisation.…”

Transradial approach for the endovascular treatment of type I endoleak after aortic aneurysm repair: a case report

“…Onyx (ev3, Irvine, CA, USA) is a relatively novel non-adhesive liquid embolic agent, which is most commonly used to treat intracranial arteriovenous malformations. It is comprised of ethylene vinyl alcohol dissolved in dimethyl sulphoxide (DMSO), an organosulfur compound frequently employed into molecular biology studies [18,19], and suspended micronized tantalum powder to provide contrast for visualization under fluoroscopy [20]. …”