CC BY-NC-ND 4.0 · The Arab Journal of Interventional Radiology 2018; 02(03): S27
DOI: 10.1055/s-0041-1730720

Superiority of Intrasac Ethylene Vinyl Alcohol Copolymer Liquid Embolic (Onyx®) Embolization Compared with Other Embolization Agents and Techniques for the Treatment of Type II Endoleaks Following Endovascular Stent-Graft Treatment of Abdominal Aortic Aneurysms

Hatim Alobaidi
Prince Sultan Military Medical city, Riyadh, Saudi Arabia
Stewart Kribs
Prince Sultan Military Medical city, Riyadh, Saudi Arabia
› Author Affiliations

Purpose: The aim of the study was to review our experience with the efficacy of ethylene vinyl alcohol copolymer liquid embolic (Onyx®) injected directed into the aneurysm sac compared with other embolic agents and techniques for the treatment of persisting type II endoleaks (after endovascular repair for abdominal aortic aneurysms [EVAR]). Methods: All patients treated at our center between April 2005 and July 2015 who underwent an embolization procedure for a persistent type II endoleak after EVAR were retrospectively reviewed. Patients were divided into three groups depending on the embolic agent used and the technique of embolization. Group 1 underwent embolization with Onyx® injected directly into the aneurysm sac, using either a transarterial or a direct sac puncture technique. Group 2 underwent embolization with agents other than Onyx®, including cyanoacrylate, also injected directly into the aneurysm sac. Group 3 included patients treated by any other embolization technique or agent. Successful treatment was defined as resolution of the endoleak on a follow-up computed tomography and <5 mm aneurysm sac expansion. Results: Thirty-nine patients underwent 56 embolization procedures. The number of patients and embolization procedures for the three groups was as follows: Group 1: 13 and 14; Group 2: 10 and11; Group 3: 21 and 31. The availability of postprocedure follow-up for the three groups was as follows: Group 1, 11/14 (79%); Group 2, 11/11 (100%); and Group 3, 26/31 (84%). Procedural success for the three groups was as follows: Group 1, 36%; Group 2, 18%; and Group 3, 23%. The success of Onyx embolization for patients in Group 1 who had only a single endoleak was 4 of 8 (50%). There was one major complication in Group 3 which was lower extremity weakness secondary to spinal infarction following embolization of a lumbar artery supplying the endoleak using polyvinyl alcohol particles. Conclusion: The success of embolization for persistent type II endoleaks following endovascular stent grafting for abdominal aortic aneurysms is limited with all embolization agents and techniques. However, Onyx® embolization injected directly into the aneurysm sac had the greatest success, especially if only one endoleak is present.

Publication History

Article published online:
11 May 2021

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