VESS29. Outcomes of Onyx Embolization of Type II Endoleaks After Endovascular Repair of Abdominal Aortic Aneurysm

Abstract

Objectives: Type II endoleaks (T2EL) are common after endovascular repair of abdominal aortic aneurysms. Although optimal technique and material to treat T2EL are ill-defined, embolization with ethylene vinyl alcohol copolymer (Onyx) has been suggested as an effective strategy. Owing to limited data supporting use and high cost, we sought to analyze outcomes of Onyx embolization for T2EL.Methods: We performed a retrospective review of patients treated for T2EL using Onyx embolization agent from 2009 to 2018. All pre-and post-Onyx intervention computed tomography scans were analyzed for diameter and volume changes with three-dimensional reconstruction software. The primary outcomes were change in maximum abdominal aortic aneurysm diameter and volume. Secondary outcomes included additional interventions, rupture, and mortality.Results: We identified 85 patients (86% men; mean age, 77.6 6 5.1 years) who underwent 112 Onyx interventions. Average time to first Onyx intervention after endovascular repair of abdominal aortic aneurysm was 3.3 6 2.6 years, and the average sac growth was 6.3 6 6.7 mm. Patients underwent 1.3 Onyx interventions using a mean of 4.9 6 4.7 mL for treatment. Three complications occurred (Onyx extravasation, colon ischemia, and access site hematoma). Mean follow-up was 2.5 6 2.1 years after initial Onyx treatment. At the most recent follow-up, sac shrinkage of greater than 5 mm was seen in 19% and sac stabilization was seen in 47%. Sac growth of greater than 5 mm was seen in 34% of patients following the first Onyx intervention. Results were similar when sac volume was analyzed. Eleven percent of the patients required additional interventions to treat separate endoleaks. Four patients experienced a rupture (three had active T1ELs). Rupture-free survival was 95% at 5 years, and overall survival was 58% at 5 years.Conclusions: Onyx for embolization of T2EL resulted in sac shrinkage or stabilization in 66% of patients. 34% had continued sac growth despite intervention. Given its high cost and similar outcomes to other embolization strategies in the literature, Onyx may not be a cost-effective method for T2EL management.Objectives: Abdominal aortic aneurysms (AAA) after endovascular aortic repair (EVAR), are routinely monitored for change in sac size and the presence of endoleaks. Recent data suggest that lack of sac regression at one year is associated with long-term mortality. However, sac behavior may change with extended follow-up. The aim of this study was to evaluate sac size change after EVAR over an extended period of time, and study association of sac behavior with mortality.Methods: Clinical data and imaging of consecutive patients undergoing EVAR for infrarenal AAA between 2000 and 2018 were reviewed retrospectively. Those with saccular and isolated internal iliac artery aneurysm indications were excluded. Maximal aneurysm diameter on axial imaging was measured on computed tomography angiography preoperatively, followed by postoperative intervals of 1 to 6 months, 1 year and 3 years. Patie...

Onyx versus coil embolization for the treatment of type II endoleaks

“…However, only four studies had had included >10 patients, and the median follow-up in the largest series by Massis et al 10 was 4 months. Mozes et al 11 recently performed a retrospective review of outcomes of Onyx embolization for type II endoleaks, including 85 patients who had undergone 112 Onyx embolization procedures. With a mean follow-up of 2.5 6 2.1 years after treatment, sac shrinkage of >5 mm was seen in 19% and sac stabilization in 47%.…”