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Rolland R, Loubet A, Bommart S, Monnin-Bares V, Zarqane H, Vanoverschelde J, Herman F, Molinari N, Kovacsik H. Safety, Efficacy and Mid-Term Outcome for Transarterial Embolization (TAE) of Renal Angiomyolipoma (AML) Using Ethylene Vinyl Alcohol Copolymer Liquid Embolic Agent (EVOH). J Clin Med 2023; 12:jcm12103385. [PMID: 37240490 DOI: 10.3390/jcm12103385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/06/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Transarterial embolization (TAE) of renal angiomyolipoma (AML) is effective in treating and preventing hemorrhage. We report our experience using EVOH with a single-center retrospective study of all AML embolized with EVOH between June 2013 and March 2022 at the Montpellier University Hospital. A total of 29 embolizations were carried out in 24 consecutive patients (mean age: 53.86 years; 21 women and 3 men) with 25 AMLs for severe bleeding, symptomatic AML, tumor size > 4 cm, or presence of aneurysm(s) > 5 mm. Data collected included imaging and clinical outcomes, tuberous sclerosis complex status, change in AML volume, rebleeding, renal function, volume and concentration of EVOH used, and complications. Out of 29 embolizations performed for 25 AMLs, four were performed in an emergency. Technical success was achieved for 24/25 AMLs. Mean AML volume reduction was 53.59% after a mean follow-up time of 446 days using MRI or CT scan. Aneurysms on angiogram and the symptomatological nature of AML, as well as secondary TAE and multiple arterial pedicles, were statistically associated (p < 0.05). Two patients (8%) underwent nephrectomy after TAE. Four patients had a second embolization. Minor and major complication rates were 12% and 8%, respectively. Neither rebleeding nor renal function impairment was noticed. TAE of AML using EVOH is, thus, highly effective and safe.
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Affiliation(s)
- Rémi Rolland
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
| | - Antoine Loubet
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
| | - Sébastien Bommart
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
| | - Valérie Monnin-Bares
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
| | - Hamid Zarqane
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
| | - Juliette Vanoverschelde
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
| | - Fanchon Herman
- Department of Medical Statistics and Epidemiology, Centre Hospitalier Universitaire Montpellier, University of Montpellier, 34090 Montpellier, France
| | - Nicolas Molinari
- Department of Medical Statistics and Epidemiology, Centre Hospitalier Universitaire Montpellier, University of Montpellier, 34090 Montpellier, France
| | - Hélène Kovacsik
- Department of Radiology, CHU of Montpellier, Arnaud de Villeneuve Hospital, 34090 Montpellier, France
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Minici R, Venturini M, Fontana F, Guzzardi G, Pingitore A, Piacentino F, Serra R, Coppola A, Santoro R, Laganà D. Efficacy and Safety of Ethylene-Vinyl Alcohol (EVOH) Copolymer-Based Non-Adhesive Liquid Embolic Agents (NALEAs) in Transcatheter Arterial Embolization (TAE) of Acute Non-Neurovascular Bleeding: A Multicenter Retrospective Cohort Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040710. [PMID: 37109668 PMCID: PMC10146444 DOI: 10.3390/medicina59040710] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Transcatheter arterial embolization (TAE) is part of the daily practice of most interventional radiologists worldwide. The ideal liquid embolic agent is far from being identified. Non-adhesive liquid embolic agents (NALEA) harden from the outside to the inside, resulting in deep penetration, known as "magma-like" progression, which permits a more distal embolization with good control of the embolic material. This multicenter retrospective cohort study aims to assess the efficacy, feasibility and safety of transcatheter arterial embolization (TAE) with ethylene-vinyl alcohol (EVOH)-based NALEAs (Onyx and Squid) in acute bleeding outside of the neurovascular area. Materials and Methods: This study is a multicenter analysis of retrospectively collected data of consecutive patients who had undergone, from January 2015 to December 2022, transcatheter arterial embolization with non-adhesive EVOH-based agents in the setting of acute non-neurovascular bleeding. Results: Fifty-three patients underwent transcatheter arterial embolization for acute non-neurovascular bleeding. Eight (15.1%) procedures were performed in patients with coagulopathy. The most used concentration of EVOH-based NALEAs was 34 (i.e., 8%), with a mean dose of 0.5 (±0.3) mL. The mean CT-to-groin time, the mean procedure time, the mean CT-to-embolization time and the mean fluoroscopy time were 22.9 (±12.4) min, 27.5 (±7) min, 50.3 (±13.1) min and 7.5 (±2.8) min, respectively. Technical success was achieved in all cases with a 96.2% clinical success rate. Complications were recorded in six (11.3%) patients. No statistically significant differences were observed between the group of patients with coagulopathy and the group of patients without coagulopathy in terms of efficacy and safety endpoints. Conclusions: Transcatheter arterial embolization (TAE) performed with non-adhesive EVOH-based embolic agents is an effective, feasible and safe strategy for the management of acute non-neurovascular bleeding, even in the subgroup of patients with coagulopathy.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, Varese 21100, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, Varese 21100, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | | | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, Varese 21100, Italy
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, University Hospital Mater Domini, 88100 Catanzaro, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, Varese 21100, Italy
| | - Rita Santoro
- Haemophilia and Thrombosis Center, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy
| | - Domenico Laganà
- Radiology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, University Hospital Mater Domini, 88100 Catanzaro, Italy
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Rabuffi P, Bruni A, Antonuccio EMG, Saraceni A, Vagnarelli S. Transarterial embolization of acute non-neurologic bleeding using Ethylene Vynil Alcohol Copolymer: a single-Centre retrospective study. CVIR Endovasc 2023; 6:2. [PMID: 36697892 PMCID: PMC9877256 DOI: 10.1186/s42155-023-00347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/04/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND To evaluate feasibility, safety and effectiveness of transarterial embolization of acute non-neurologic hemorrhage with Ethylene Vynil Alcohol Copolymer (EVOH). METHODS Between January 2018 and June 2021, 211 patients (male 123, mean age 69.7 y + 17.9) who underwent transarterial embolization with Onyx™ for acute non-neurologic arterial bleeding were retrospectively reviewed. Most frequent etiology of bleeding was post-operative (89/211, 42.2%), trauma (62/211, 29.4%) and tumor (18/211, 8.5%). Technical success was defined as the angiographic evidence of target vessel complete occlusion. Clinical success was defined as resolution of bleeding. Any rebleeding within the primitive site, requiring a new intervention during the first 30-days following embolization, was considered a clinical failure. Occurrence of procedure-related complication and mortality within 30 days of the embolization were examined. RESULTS A total of 229 embolization procedures was performed in 211 pts.; technical success rate was 99.5% (210/211 pts). Clinical success rate was 94.3% (199/211 pts). In 11 patients (5.2%) a reintervention was needed because of a rebleeding occurring within the primitive site, whereas in five patients (2.4%) rebleeding occurred within a site different from the primitive. Factors more often associated with clinical failure were coagulopathy/ongoing anticoagulant therapy (5/11, 45.4%), and post-operative etiology (3/11, 27.3%). EVOH was used as the sole embolic agent in 214/229 procedures (93.4%), in association with coils in 11 cases (4.8%), and with microparticles in 4 cases (1.7%). In the present series, major complications occurred in 6 cases (2.8%): respectively, four cases (1.9%) of colonic ischemia and two groin hematomas (0.9%) with active extravasation were observed. 26 (12.3%) patients died during the follow-up. CONCLUSION Embolization of acute arterial bleeding with EVOH as a first-line embolic agent is feasible, safe and effective.
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Affiliation(s)
- Paolo Rabuffi
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
| | - Antonio Bruni
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
| | - Enzo Maria Gabriele Antonuccio
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
| | - Andrea Saraceni
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
| | - Simone Vagnarelli
- grid.415032.10000 0004 1756 8479Unit of Interventional Radiology, Azienda Ospedaliera San Giovanni Addolorata, Via dell’Amba Aradam 9, 00184 Rome, Italy
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Bronchial artery embolization for hemoptysis: A systematic review and meta-analysis. J Interv Med 2021; 4:172-180. [PMID: 35586385 PMCID: PMC8947981 DOI: 10.1016/j.jimed.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 11/20/2022] Open
Abstract
Objective To assess the safety and efficacy of bronchial artery embolization (BAE) for hemoptysis. Methods and materials Databases with articles published in English, including Pubmed, Embase, Web of science and Chochrane library, were comprehensively searched to get accurate, up-to-date and sufficient literature about BAE for hemoptysis until March 2020. The technical success rates, immediate control rates, recurrence rates, mortality rates, and total complication rates (minor and major complication rates) extracted from the articles were pooled to estimate and assess the efficacy and safety of BAE using random-effect and fixed-effect models. Results 21 articles published between 2008 and 2019, which include a total of 2511 patients, were studied to evaluate the safety and efficacy of BAE. The technical success and immediate control rates are 99.9% (95%CI: 99%–100%) and 99.5% (95%CI: 97.8%–99.2%), respectively. This study showed hemoptysis recurrence in 23.7% (95%CI: 18.5%–28.9%) with a mortality rate of 2% (95%CI: 0–3%). Additionally, the assessment of complications revealed a total complication rate of 13.4% (95% CI: 7.6–19.2%), in which 0.2% (95% CI: 0.2–0.4%) were major complications and 10% (95% CI: 4.7–9.6%) were minor complications. Conclusion BAE is an effective, safe, and feasible procedure with a low complication rate for hemoptysis patients. However, recurrence of hemoptysis is still at high risk after BAE due to different underlying diseases.
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Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature. J Clin Med 2021; 10:jcm10214841. [PMID: 34768362 PMCID: PMC8584511 DOI: 10.3390/jcm10214841] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 12/28/2022] Open
Abstract
This review focuses on the use of “new” generation of non-adhesive liquid embolic agents (NALEA). In literature, non-adhesive liquid embolic agents have mainly been used in the cerebral district; however, multiple papers describing the use of NALEA in the extracranial district have been published recently and the aim of this review is to explore and analyze this field of application. There are a few NALEA liquids such as Onyx, Squid, and Phil currently available in the market, and they are used in the following applications: mainly arteriovenous malformations, endoleaks, visceral aneurysm or pseudoaneurysm, presurgical and hypervascular lesions embolization, and a niche of percutaneous approaches. These types of embolizing fluids can be used alone or in combination with other embolizing agents (such as coils or particles) so as to enhance its embolizing effect or improve its possible defects. The primary purpose of this paper is to evaluate the use of NALEAs, predominantly used alone, in elective embolization procedures. We did not attempt a meta-analysis due to the data heterogeneity, high number of case reports, and the lack of a consistent follow-up time period.
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Razavilar N, Taleshi JM. Cost-Effectiveness Analysis of Transcatheter Arterial Embolization Techniques for the Treatment of Gastrointestinal Bleeding in the United States. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:477-485. [PMID: 33840425 DOI: 10.1016/j.jval.2020.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/04/2020] [Accepted: 10/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Gastrointestinal (GI) bleeding is a common medical emergency associated with significant mortality. Transcatheter arterial embolization first was introduced by Rosch et al as an alternative to surgery for upper GI bleeding. The clinical success in patients with GI bleeding treated with transcatheter arterial embolization previously has been reported. However, there are no cost-effectiveness analyses reported to date. Here we report cost-effectiveness analysis of N-butyl 2-cyanoacrylate glue (NBCA) and ethylene-vinyl alcohol copolymer (Onyx) versus coil (gold standard) for treatment of GI bleeding from a healthcare payer perspective. METHODS Fixed-effects modeling with a generalized linear mixed method was used in NBCA and coil intervention arms to determine the pooled probabilities of clinical success and mortality with complications with their confidence intervals, while the Clopper-Pearson model was used for Onyx to determine the same parameters. Models were provided by the "Meta-Analysis with R" software package. A decision tree was built for cost-effectiveness analysis, and Microsoft Excel was used for probabilistic sensitivity analysis. The cost-effective option was determined based on the incremental cost-effectiveness ratio and scatter plots of incremental cost versus incremental quality-adjusted life-years. RESULTS Comparing scatter plots and incremental cost-effectiveness ratio results, -$1024 and -$1349 per quality-adjusted life-year for Onyx and N-butyl 2-cyanoacrylate glue, respectively, Onyx was the least expensive and most effective intervention. CONCLUSION Onyx was the dominant strategy regardless of threshold values. Our analyses provide a framework for researchers to predict the target clinical effectiveness for early-stage TAE interventions and guide resource allocation decisions.
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Affiliation(s)
- Negin Razavilar
- RAZN Health Decision Modelling LTD, University of Alberta Health Accelerator, Edmonton, Canada; Faculty of Sciences, University of Alberta, Edmonton, Canada.
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Lucatelli P, Corona M, Teodoli L, Nardis P, Cannavale A, Rocco B, Trobiani C, Cipollari S, Zilahi de Gyurgyokai S, Bezzi M, Catalano C. Use of Phil Embolic Agent for Bleeding in Non-Neurological Interventions. J Clin Med 2021; 10:jcm10040701. [PMID: 33670124 PMCID: PMC7916888 DOI: 10.3390/jcm10040701] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 01/26/2023] Open
Abstract
Objective: To evaluate the safety and efficacy of the Phil liquid embolic agent in non-neurological embolization procedures. M&M: Thirty-five patients with a mean age of 62.5 years underwent percutaneous embolization using Phil for the treatment of visceral arterial bleedings in 20/35 patients (including three gluteal, one bladder, two superior mesenteric, three epigastric, one deep femoral, five internal iliac, four intercostal, and one lingual arteries), splanchnic pseudoaneurysms in 11/35 patients (including three hepatic, five splenic, and three renal arteries), pancreatic bleeding metastasis in 1/35 patient, and gastric bleeding varices in 3/35 patients. Phil is composed of a non-adhesive copolymer dissolved in DMSO (Anhydrous Dimethyl Sulfoxide) with different viscosity. Procedures were performed slowly under continuous fluoroscopic guidance to avoid embolization of non-target vessels. Results: Clinical success was obtained with a single intervention in 34 cases (97.15%), while a repeated procedure was required in one case (2.85%). No technical complications nor non-target embolization occurred. A case of post-embolic syndrome was noted (2.85%) in one patient. DMSO administration-related pain was successfully controlled by medical therapy. Conclusion: Phil can be considered a safe and effective embolic agent for the treatment of non-neurologic bleeding.
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Mattay RR, Shlansky-Goldberg R, Pukenas BA. Recurrent massive hemoptysis in a patient with cystic fibrosis: balloon assisted Onyx embolization after bronchial artery coil recanalization. CVIR Endovasc 2021; 4:4. [PMID: 33400002 PMCID: PMC7785756 DOI: 10.1186/s42155-020-00200-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
Background Although not standard of care, Cystic Fibrosis patients with recurrent hemoptysis occasionally have coil embolization of bronchial arteries. In the event of recanalization of these arteries in this specific subset of patients, the presence of indwelling coils makes the prospect of conventional particle embolization more difficult, preventing both adequate catheterization of the coiled segment and reflux of the particles. Case presentation In this report, we describe a case of bronchial artery embolization of a complex Cystic Fibrosis patient with massive hemoptysis from recanalized coiled bronchial arteries utilizing a Scepter Balloon Catheter® (Microvention Terumo, USA) in administration of the liquid embolic agent Onyx® (Medtronic, USA). Conclusions The Scepter occlusion balloon catheter allowed for careful placement of the tip within the interstices of the pre-existing coils, allowing for Onyx injection directly into the coil mass without reflux, reconfirming the benefits of Onyx embolization in bronchial artery embolization and providing evidence that the Scepter occlusion balloon catheter should be added to the armamentarium of devices used in complex bronchial artery embolization for Cystic Fibrosis patients with massive hemoptysis.
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Affiliation(s)
- Raghav R Mattay
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Richard Shlansky-Goldberg
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Bryan A Pukenas
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
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Salaskar AL, Razjouyan F, Cho AL, Sood RR, Akman A, Scher D, Venbrux AC, Sarin SN. Single institutional experience of peripheral applications of a liquid embolic agent: Ethylene Vinyl Alcohol Copolymer. CVIR Endovasc 2020; 3:38. [PMID: 32743749 PMCID: PMC7396416 DOI: 10.1186/s42155-020-00117-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 04/03/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of ethylene vinyl alcohol (EVOH) copolymer for the treatment of a variety of peripheral vascular pathologies. RESULTS Between October 2010 and October 2017, 43 patients who underwent total 54 EVOH embolization procedures for the treatment of peripheral vascular pathologies were included. The cases which involved the use of EVOH for the treatment of nonvascular, neurologic, ophthalmologic, otolaryngologic or head-neck pathologies were excluded. The demographic data, technical and clinical success rates, and procedure-related details and complications were obtained. The most common indications for EVOH embolization were type II endoleaks (n = 18) and peripheral arteriovenous malformations (n = 14). The majority of cases (62.5%) used EVOH without any adjunct embolic material. The results of this study showed 100% technical success rates and 89% clinical success rates. No events of nontarget embolization or other procedure-related complications were noted. The mortality & morbidity rates were 0%. The loss to follow up rate was 16% (9 /54). The mean follow-up period was 134 days (range, 30 to 522 days). CONCLUSION The single institutional experience supports the safety and efficacy of EVOH embolization in the treatment of various peripheral vascular conditions.
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Affiliation(s)
- Abhijit L Salaskar
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA.
| | - Faezeh Razjouyan
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Alexander L Cho
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Rishi R Sood
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Andrew Akman
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Daniel Scher
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Anthony C Venbrux
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
| | - Shawn N Sarin
- Division of Vascular and Interventional Radiology, George Washington University Hospital, Washington, DC, 20037, USA
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Né R, Chevallier O, Falvo N, Facy O, Berthod PE, Galland C, Gehin S, Midulla M, Loffroy R. Embolization with ethylene vinyl alcohol copolymer (Onyx ®) for peripheral hemostatic and non-hemostatic applications: a feasibility and safety study. Quant Imaging Med Surg 2018; 8:280-290. [PMID: 29774181 DOI: 10.21037/qims.2018.04.03] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Onyx® is a liquid embolic agent, which is approved for the treatment of cerebral vascular lesions but still rarely used in peripheral interventional radiology. The goal of this study is to report the feasibility and safety of embolization with Onyx® for peripheral hemostatic and non-hemostatic endovascular procedures. Methods Retrospective study of all consecutive patients who underwent visceral or peripheral embolization with Onyx® for hemostatic or non-hemostatic purpose in our department between May 2014 and November 2016. Demographic data, clinical presentation, underlying etiology, culprit vessel, endovascular procedure, pain during embolization, outcomes, and follow-up data were collected. Results Fifty patients (males, 34; females, 16; mean age, 56±18 years; range, 15-89 years) were included. Twenty-nine (58%) of patients underwent hemostatic embolization for arterial (n=22, 44%) or venous (n=7, 14%) bleeding lesions, whereas 21 (42%) of patients underwent non-hemostatic embolization for arterial aneurysms (n=8, 16%), preoperative portal vein deprivation (n=6, 12%) or other indications (n=7, 14%). Onyx-18 was used in 37 (74%) patients, Onyx-34 in 9 (18%) patients, and a combination of both in 4 (8%) patients. Onyx was used alone in 25 (50%) patients and in combination with other agent in 25 (50%) patients. Mean number of Onyx® vials used was 3.7 (range, 1-17). Immediate technical success rate was 100%. Primary clinical success was achieved in all patients. Recurrent bleeding occurred in two patients. Significant pain (pain score ≥3) was noted during injection in 10 (20%) patients. No major complication or side effects were noted within 1 month. Conclusions 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.
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Affiliation(s)
- Romaric Né
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Nicolas Falvo
- Department of Angiology and Vascular Medicine, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Olivier Facy
- Department of Digestive and Visceral Surgery, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Pierre-Emmanuel Berthod
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Christophe Galland
- Department of Angiology and Vascular Medicine, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Sophie Gehin
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, François-Mitterrand Teaching Hospital, University of Burgundy, Dijon, France
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Xu W, Wang HH, Bai B. Emergency transcatheter arterial embolization for massive hemoptysis due to pulmonary tuberculosis and tuberculosis sequelae. Cell Biochem Biophys 2015; 71:179-87. [PMID: 25134662 DOI: 10.1007/s12013-014-0182-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To explore the strategy and curative effect of emergency transcatheter arterial embolization (ETAE) in patients with massive hemoptysis due to pulmonary tuberculosis and tuberculosis sequelae. A total of 148 patients with massive hemoptysis due to pulmonary tuberculosis underwent emergency arteriography. After the bleeding artery was located, patients were given embolotherapy using gelfoam strips, coils, and polyvinyl alcohol particles. The arteriography manifestations and therapeutic outcomes in all patients were retrospectively analyzed. ETAE was performed successfully in 143 patients after location of the bleeding arteries. The bleeding arteries could not be located in another five patients, and embolotherapy, therefore, could not be performed. Among these five patients, three underwent surgical resection and two died of complications of tuberculosis/fungal ball coinfection. During a 2-year follow-up period, there were 15 cases of recurrent hemoptysis after initial embolotherapy. Among these, four cases were resolved by re-embolization, 11 patients still had massive hemoptysis after re-embolization who underwent surgical resection and resolved the hemoptysis eventually. Successful hemostasis was achieved by ETAE in 132 patients (89.19%; 132/148). No severe complications occurred after embolotherapy. ETAE is a safe and effective treatment for massive hemoptysis due to pulmonary tuberculosis. The key to successful treatment is thorough and complete embolization of the bleeding arteries. In the event of failure of embolotherapy, surgical resection should be used to resolve the bleeding.
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Affiliation(s)
- Wei Xu
- Department of Interventional Radiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150086, China
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Kolber MK, Shukla PA, Kumar A, Silberzweig JE. Ethylene Vinyl Alcohol Copolymer (Onyx) Embolization for Acute Hemorrhage: A Systematic Review of Peripheral Applications. J Vasc Interv Radiol 2015; 26:809-15. [DOI: 10.1016/j.jvir.2015.02.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/14/2015] [Accepted: 02/25/2015] [Indexed: 12/15/2022] Open
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Ethylene vinyl alcohol copolymer (Onyx®) in peripheral interventional radiology: indications, advantages and limitations. Diagn Interv Imaging 2015; 96:319-26. [PMID: 25704146 DOI: 10.1016/j.diii.2014.11.030] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 11/21/2014] [Accepted: 11/24/2014] [Indexed: 12/31/2022]
Abstract
Onyx(®) is a remarkable liquid embolizing agent that may allow a well-trained operator to undertake challenging embolization procedures. In multiple interventional radiology indications, the physico-chemical properties of Onyx(®) allow safe embolization. The purpose of this article is to review the advantages and disadvantages of Onyx(®) and identify its main indications.
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Abstract
Hemoptysis represents a significant clinical entity with high morbidity and potential mortality. Most hemorrhages from a bronchial source arise in the setting of chronic inflammatory diseases. Medical management (in terms of resuscitation and bronchoscopic interventions) and surgery have severe limitations in these patient populations. Embolization procedures represent the first-line treatment for hemoptysis arising from a bronchial arterial source. This article discusses anatomical and technical considerations, as well as outcomes and complications, in the setting of bronchial arterial embolization in the treatment of hemoptysis.
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Ao M, Guo SL, Zhang XD, Li YL, Li Y, Li Q. First case in China: Onyx for bronchial artery embolization in treatment of refractory massive hemoptysis in one case. J Thorac Dis 2013; 5:E98-E102. [PMID: 23825793 DOI: 10.3978/j.issn.2072-1439.2013.05.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 05/25/2013] [Indexed: 11/14/2022]
Affiliation(s)
- Min Ao
- Department of Respiratory Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Reply to Letter: Onyx for Embolization of Life-Threatening Hemoptysis: A Promising but Luxury Embolic Agent! Cardiovasc Intervent Radiol 2011. [DOI: 10.1007/s00270-011-0334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Onyx for Embolization of Life-Threatening Hemoptysis: A Promising but Luxury Embolic Agent! Cardiovasc Intervent Radiol 2011; 35:221; author reply 222. [DOI: 10.1007/s00270-011-0331-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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