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Pal A, Blanzy J, Gómez KJR, Preul MC, Vernon BL. Liquid Embolic Agents for Endovascular Embolization: A Review. Gels 2023; 9:gels9050378. [PMID: 37232970 DOI: 10.3390/gels9050378] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/11/2023] [Accepted: 05/02/2023] [Indexed: 05/27/2023] Open
Abstract
Endovascular embolization (EE) has been used for the treatment of blood vessel abnormalities, including aneurysms, AVMs, tumors, etc. The aim of this process is to occlude the affected vessel using biocompatible embolic agents. Two types of embolic agents, solid and liquid, are used for endovascular embolization. Liquid embolic agents are usually injectable and delivered into the vascular malformation sites using a catheter guided by X-ray imaging (i.e., angiography). After injection, the liquid embolic agent transforms into a solid implant in situ based on a variety of mechanisms, including polymerization, precipitation, and cross-linking, through ionic or thermal process. Until now, several polymers have been designed successfully for the development of liquid embolic agents. Both natural and synthetic polymers have been used for this purpose. In this review, we discuss embolization procedures with liquid embolic agents in different clinical applications, as well as in pre-clinical research studies.
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Affiliation(s)
- Amrita Pal
- Center for Interventional Biomaterials, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - Jeffrey Blanzy
- Center for Interventional Biomaterials, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - Karime Jocelyn Rosas Gómez
- Center for Interventional Biomaterials, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
| | - Mark C Preul
- The Loyal and Edith Davis Neurosurgical Research Laboratory, Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ 85013, USA
| | - Brent L Vernon
- Center for Interventional Biomaterials, School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
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Zehtabi F, Montazerian H, Haghniaz R, Tseng K, Mohaghegh N, Mandal K, Zamanian B, Dokmeci MR, Akbari M, Najafabadi AH, Kim HJ, Khademhosseini A. Sodium Phytate-Incorporated Gelatin-Silicate Nanoplatelet Composites for Enhanced Cohesion and Hemostatic Function of Shear-Thinning Biomaterials. Macromol Biosci 2023; 23:e2200333. [PMID: 36287084 PMCID: PMC9851971 DOI: 10.1002/mabi.202200333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/22/2022] [Indexed: 01/22/2023]
Abstract
Shear-thinning biomaterials (STBs) based on gelatin-silicate nanoplatelets (SNs) are emerging as an alternative to conventional coiling and clipping techniques in the treatment of vascular anomalies. Improvements in the cohesion of STB hydrogels pave the way toward their translational application in minimally invasive therapies such as endovascular embolization repair. In the present study, sodium phytate (Phyt) additives are used to tune the electrostatic network of SNs-gelatin STBs, thereby promoting their mechanical integrity and facilitating injectability through standard catheters. We show that an optimized amount of Phyt enhances storage modulus by approximately one order of magnitude and reduces injection force by ≈58% without compromising biocompatibility and hydrogel wet stability. The Phyt additives are found to decrease the immune responses induced by SNs. In vitro embolization experiments suggest a significantly lower rate of failure in Phyt-incorporated STBs than in control groups. Furthermore, the addition of Phyt leads to accelerated blood coagulation (reduces clotting time by ≈45% compared to controls) due to the contributions of negatively charged phosphate groups, which aid in the prolonged durability of STB in coagulopathic patients. Therefore, the proposed approach is an effective method for the design of robust and injectable STBs for minimally invasive treatment of vascular malformations.
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Affiliation(s)
- Fatemeh Zehtabi
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Hossein Montazerian
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California 90095, United States
- California NanoSystems Institute, University of California, Los Angeles, Los Angeles, California 90095, United States
| | - Reihaneh Haghniaz
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Kaylee Tseng
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
- Department of Chemical Engineering and Materials Science, University of Southern California, Los Angeles, California 90007, United States
| | - Neda Mohaghegh
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Kalpana Mandal
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Behnam Zamanian
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Mehmet Remzi Dokmeci
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Mohsen Akbari
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
- Laboratory for Innovations in Micro Engineering (LiME), Department of Mechanical Engineering, University of Victoria, Victoria, British Columbia V8P 5C2, Canada
- Biotechnology Center, Silesian University of Technology, Akademicka 2A, 44-100, Gliwice, Poland
| | | | - Han-Jun Kim
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
| | - Ali Khademhosseini
- Terasaki Institute for Biomedical Innovation, Los Angeles, California 90024, United States
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Akmal MM, Pabittei DR, Prapassaro T, Suhartono R, Moll FL, van Herwaarden JA. A systematic review of the current status of interventions for type II endoleak after EVAR for abdominal aortic aneurysms. Int J Surg 2021; 95:106138. [PMID: 34637951 DOI: 10.1016/j.ijsu.2021.106138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 08/18/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the mid- and long-term outcomes of type II endoleak treatment after EVAR and the technical aspects of different techniques to exclude endoleaks which different embolic agents. METHODS A systematic review was performed using the approach recommended by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for meta-analyses of interventional studies. The comprehensive search was conducted using the following database: MEDLINE, EMBASE, and the Cochrane Library. Patient characteristic, intervention approaches, embolic agents, and results at mid and long term follow up were studied. RESULTS A total of 6 studies corresponding to a total of 141 patients fulfilled the inclusion criteria with a mean age of 73-78.6 years and a mean duration of follow up varying from 25 to 42 months. There were different techniques for embolization used (translumbar, transarterial, and transcaval approach) with various types of embolic agents. In all studies, the indication for embolization of the type II endoleaks was sac enlargement of more than 5 mm. A wide range of technical success rate was reported regardless of the intervention strategy being used (17,6%-100%). The overall technical success rate of all studies was 62%. CONCLUSION This systematic review shows that there is a wide variety of techniques to exclude a persistent type II endoleak. Different kinds of embolic agents have be used. Due to a lack of peer reviewed data on longterm follow-up, it was not possible to come to recommendations what treatment would be the best for a durable exclusion of a persistent type II endoleak after an initially successful EVAR. There remains an urgent need for proper executed studies, either randomized or with close observation in relation to longer follow-up.
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Affiliation(s)
- Marethania M Akmal
- Departement of vascular surgery, University Medical Center Utrecht, Utrecht, the Netherlands Vascular surgery Division, Departement of Surgery, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Indonesia Departement of Physiology, Hasanudin University, Indonesia Departement of vascular surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Hamidizadeh R, Nzekwu E, Halliwell O. Factors Influencing Clinical Success Following Endovascular Treatment of Type II Endoleaks. Can Assoc Radiol J 2020; 72:890-897. [PMID: 33371728 DOI: 10.1177/0846537120981100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To compare long-term outcomes of transarterial (TA) and translumbar (TL) embolization of type II endoleaks (T2E) following EVAR, as well as factors that predict clinical success. METHODS 129 (mean age, 71.4y; range, 53-95) with T2E referred for embolization from August-2003 to December-2017 were retrospectively reviewed. One-hundred-eighty procedures were performed via TA (n = 139) and TL (n = 41) approaches, with 37 patients undergoing 51 reinterventions. Clinical success was defined as absence of endoleak and/or absence of aneurysm sac enlargement on follow-up imaging. Medical comorbidities, procedural data, embolic agents used, presence of successful sac embolization, and 30-day morbidity and mortality data were collected. RESULTS TL approaches had higher technical success (41/41 vs.122/139, p = .014). Clinical success rates were 52% (N = 58/111) and 62% (N = 23/37) for TA and TL procedures respectively (p = .34). Looking at all procedures, sac embolization using n-butyl cyanoacrylate glue had higher clinical success compared to other embolic agents (p = .017-.037). Successful sac access was a strong predictor of success for TA procedures (46/78 vs.12/33, p = .0379). 30-day complication rates were similar between TA (5.8%) and TL (4.9%) approaches. There was 1 death secondary to graft infection following TA embolization. CONCLUSIONS Overall clinical success of TA and TL embolization when considering re-interventions is high. n-butyl cyanoacrylate glue had significantly higher success than other embolic agents (p = .017-.037). Successful sac access was associated with success for TA procedures.
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Affiliation(s)
- Ramin Hamidizadeh
- 70401Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Emeka Nzekwu
- 70401Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Oliver Halliwell
- 70401Cumming School of Medicine, University of Calgary, Alberta, Canada
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Mozes GD, Pather K, Oderich GS, Mirza A, Colglazier JJ, Shuja F, Mendes BC, Kalra M, Bjarnason H, Bower TC, Huang Y, Gloviczki P, DeMartino RR. Outcomes of Onyx® Embolization of Type II Endoleaks After Endovascular Repair of Abdominal Aortic Aneurysms. Ann Vasc Surg 2020; 67:223-231. [PMID: 32173471 DOI: 10.1016/j.avsg.2020.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/27/2020] [Accepted: 02/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Type II endoleaks (T2ELs) are common following endovascular repair of abdominal aortic aneurysms (EVAR). Embolization with ethylene vinyl alcohol copolymer (Onyx) may present an effective treatment alternative for T2ELs. Due to limited data supporting its use, we sought to analyze outcomes of Onyx embolization for T2ELs. METHODS Retrospective review of consecutive patients treated for T2ELs utilizing Onyx embolization agent from 2009-2018. All pre- and post-Onyx intervention CT scans were analyzed for diameter and volume changes with 3D reconstruction software. The primary outcomes were change in maximum AAA diameter and volume. Secondary outcomes included additional interventions, rupture, and mortality. A subset analysis was performed with patients with isolated T2ELs (no other types of endoleaks present). RESULTS We identified 85 patients (73 males, mean age 77.6 ± 7.6 years) who underwent 112 Onyx interventions. Average time to first Onyx intervention after index EVAR was 3.3 ± 2.6 years and average sac growth was 6.3 ± 6.7 mm. Patients underwent mean 1.3 Onyx interventions using a mean of 4.9 ± 4.7 ml for treatment. Three complications occurred (Onyx extravasation, colon ischemia, and access site hematoma). Mean follow-up was 2.5 ± 2.1 years after initial Onyx treatment. At the most recent follow-up, sac diameter stabilization was seen in 47% and reduction >5 mm was seen in 19%. Sac growth of >5 mm was seen in 34% of patients following the first Onyx intervention. In our subset of isolated T2EL, 72% had sac stabilization or reduction >5 mm. Four patients experienced a ruptured aneurysm (3 had active type 1 endoleaks). Rupture-free survival was 95% at 5 years, and overall survival was 54% at 5 years. Notably, increasing Onyx interventions were not associated with sac stabilization or reduction (OR 0.6, P = 0.1). On multivariable analysis, AAA sac diameter stabilization or reduction was independently associated with BMI >30 kg/m2 (OR 4.2, P = 0.01) and having only 1 Onyx intervention (OR 3.8, P = 0.02). CONCLUSIONS Onyx for embolization of T2ELs resulted in AAA sac diameter stabilization or reduction in 66% of patients, and up to 72% in isolated T2ELs. Further, increasing Onyx interventions were not associated with either aneurysm sac stabilization or reduction. Given its similar outcomes to other embolization strategies in the literature, Onyx embolization for management of T2ELs needs to be judiciously considered, particularly for T2ELs persisting after an initial Onyx embolization intervention.
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Affiliation(s)
- Gergely D Mozes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Keouna Pather
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Gustavo S Oderich
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Aleem Mirza
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Jill J Colglazier
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Fahad Shuja
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Bernardo C Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Manju Kalra
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Haraldur Bjarnason
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Thomas C Bower
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Ying Huang
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN
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Ushijima Y, Asayama Y, Nishie A, Ishigami K, Takayama Y, Okamoto D, Fujita N, Morita K, Honda H. Safety and Efficacy of Embolization Using N-Butyl Cyanoacrylate via a Percutaneous Direct Approach for Endoleaks after Abdominal/Thoracic Endovascular Aortic Repair. INTERVENTIONAL RADIOLOGY 2020; 5:1-9. [PMID: 36284832 PMCID: PMC9550392 DOI: 10.22575/interventionalradiology.2018-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 08/24/2019] [Indexed: 10/31/2022]
Abstract
Purpose: To elucidate the safety and efficacy of embolization using N-butyl cyanoacrylate (NBCA) for endoleaks after abdominal/thoracic endovascular aortic repair (EVAR/TEVAR) via a direct percutaneous approach versus a transarterial approach. Materials and Methods: The retrospective design of the study was approved by the institutional ethics committee, and the requirement for informed written consent was waived. Sixteen patients underwent embolization for endoleaks after EVAR/TEVAR, which was diagnosed as type II, from March 2010 to December 2013 at our institution. The number of embolization sessions was 21. A direct percutaneous approach was used in 10 sessions, and a transarterial approach was used in 11 sessions. There were 11 and 15 embolic sites for the two approaches, respectively. The procedure time, amount of contrast media used, therapeutic effect, and complications were evaluated. Results: The mean procedure time (per embolic site) was 100 min (53-170) in the direct percutaneous approach, which was significantly shorter than the 191 min (76-275) in the transarterial approach. The mean amount of contrast media used during the procedure (per embolic site) was 12.8 ml (3-25) by the direct percutaneous approach, which was significantly lesser than the 71.8 ml (30-180) in the transarterial approach. Local control of the embolic site and interval increase in the size of aneurysm after embolization were not significantly different between the two approaches. In one case each, mesenteric hematoma and migration of the embolic agent occurred with a direct percutaneous approach, and a small arterial injury occurred with the transarterial approach; aneurysmal rupture/perianeurysmal hematoma and neurological dysfunction were not observed. Conclusion: A direct percutaneous approach is a feasible procedure for embolization of endoleaks after EVAR/TEVAR.
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Affiliation(s)
- Yasuhiro Ushijima
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Yoshiki Asayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Akihiro Nishie
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Kousei Ishigami
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Yukihisa Takayama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Daisuke Okamoto
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Nobuhiro Fujita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Koichiro Morita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University
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Ierardi AM, Pesapane F, Arrichiello A, Fontana F, Piacentino F, Carrafiello G. Migration of Ethylene Vinyl Alcohol Co-Polymer in the Urinary Tract Successfully Managed. ACTA ACUST UNITED AC 2019; 55:medicina55060234. [PMID: 31159307 PMCID: PMC6630371 DOI: 10.3390/medicina55060234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/09/2019] [Accepted: 05/28/2019] [Indexed: 01/15/2023]
Abstract
Selective embolization is the treatment of choice for traumatic renal pseudoaneurysm. The use of ethylene vinyl alcohol copolymer (EVOH) was recently described as an embolic agent in peripheral lesions. The aim of a good embolic agent is to: achieve rapid and effective embolization; reach and fill distal vasculature targeted for embolization; be easy to prepare and use. Moreover, it should be highly radiopaque, controllable during administration, biocompatible and cost-effective. EVOH is a non-adhesive embolic agent and its efficacy is independent from the coagulant status. The risk of non-targeted embolization should be reduced by the good radio-opacity of the embolic material that is injected under continuous fluoroscopy. Nevertheless, symptomatic EVOH migration was described. We report a unique case of embolization of a renal pseudoaneurysm and migration of EVOH in the urinary tract. Retrograde trans-urethral removal of the migrated embolic agent was successfully performed. Our case report indicates that EVOH may not be appropriate when a fistula with renal calyx is suspected, even if its migration in the urinary tract may be managed.
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Affiliation(s)
- Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, University of Milan, Via di Rudinì 8, 20142 Milan, Italy.
| | - Filippo Pesapane
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy.
| | - Antonio Arrichiello
- Diagnostic and Interventional Radiology Department, University of Milan, Via di Rudinì 8, 20142 Milan, Italy.
| | - Federico Fontana
- Radiology Department, Insubria University, Viale Borri 57, 21100 Varese, Italy.
| | - Filippo Piacentino
- Radiology Department, Insubria University, Viale Borri 57, 21100 Varese, Italy.
| | - Gianpaolo Carrafiello
- Radiology Department, Foundation IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy.
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Fatimi A. Chitosan-based embolizing hydrogel for the treatment of endoleaks after endovascular aneurysm repair. INT J POLYM MATER PO 2019. [DOI: 10.1080/00914037.2018.1525729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ahmed Fatimi
- Department of Chemistry, Facuté Polydisciplinaire, Sultan Moulay Slimane University, Béni-Mellal, Morocco
- Laboratory of Biological Engineering, Faculté des Sciences et Techniques, Sultan Moulay Slimane University, Béni-Mellal, Morocco
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Ultee KHJ, Büttner S, Huurman R, Bastos Gonçalves F, Hoeks SE, Bramer WM, Schermerhorn ML, Verhagen HJM. Editor's Choice - Systematic Review and Meta-Analysis of the Outcome of Treatment for Type II Endoleak Following Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2018; 56:794-807. [PMID: 30104089 DOI: 10.1016/j.ejvs.2018.06.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 06/06/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The efficacy and need for secondary interventions for type II endoleaks following endovascular abdominal aortic aneurysm repair (EVAR) remain controversial. This systematic review aimed at investigating the clinical outcomes of different type II endoleak treatments in patients with a persistent type II endoleak after EVAR. DATA SOURCES Embase, Medline via Ovid, Web of Science Core Collection, the Cochrane CENTRAL, and Google Scholar. REVIEW METHODS This systematic review was performed in accordance with the PRISMA Statement. Outcomes of interest were technical and clinical success, change in sac diameter, complications, need for additional interventions, abdominal aortic aneurysm (AAA) rupture, and (AAA related) mortality. Meta-analyses were performed with random effects models. RESULTS A total of 59 studies were included, with a cumulative cohort of 1073 patients with persistent type II endoleak. Peri-operative complications following treatment of type II endoleaks occurred in 3.8% of patients (95% CI 2.7-5.2%), and AAA related mortality was 1.8% (95% CI 1.1-2.7%). Overall technical success was 87.9% (95% CI 83.1-92.1%), while clinical success was 68.4% (95% CI 61.2-75.1%). Among studies detailing sac dynamics, decrease or stable sac, with or without resolution, was achieved in 78.4% (95% CI 70.2-85.6%). Changes in sac diameter following type II endoleak treatment were documented in 157 patients to at least 24 months. Within this group an actual decrease in sac diameter was reported in only 27 of 40 patients. CONCLUSION There is little evidence supporting the efficacy of secondary intervention for type II endoleaks after EVAR. Although generally safe, the lack of evidence supporting the efficacy of type II endoleak treatment leads to difficulty in assessing its merits.
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Affiliation(s)
- Klaas H J Ultee
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Stefan Büttner
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Roy Huurman
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Frederico Bastos Gonçalves
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands; Hospital de Santa Marta, CHLC & NOVA Medical School, Lisbon, Portugal
| | - Sanne E Hoeks
- Department of Anaesthetics, Erasmus University Medical Centre, The Netherlands
| | - Wichor M Bramer
- Medical Library, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - Marc L Schermerhorn
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Centre and Harvard Medical School, Boston, MA, USA
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
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Zehtabi F, Ispas-Szabo P, Djerir D, Sivakumaran L, Annabi B, Soulez G, Mateescu MA, Lerouge S. Chitosan-doxycycline hydrogel: An MMP inhibitor/sclerosing embolizing agent as a new approach to endoleak prevention and treatment after endovascular aneurysm repair. Acta Biomater 2017; 64:94-105. [PMID: 28927932 DOI: 10.1016/j.actbio.2017.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/13/2017] [Accepted: 09/15/2017] [Indexed: 12/26/2022]
Abstract
The success of endovascular repair of abdominal aortic aneurysms remains limited due to the development of endoleaks. Sac embolization has been proposed to manage endoleaks, but current embolizing materials are associated with frequent recurrence. An injectable agent that combines vascular occlusion and sclerosing properties has demonstrated promise for the treatment of endoleaks. Moreover, the inhibition of aneurysmal wall degradation via matrix metalloproteinases (MMPs) may further prevent aneurysm progression. Thus, an embolization agent that promotes occlusion, MMP inhibition and endothelial ablation was hypothesized to provide a multi-faceted approach for endoleak treatment. In this study, an injectable, occlusive chitosan (CH) hydrogel containing doxycycline (DOX)-a sclerosant and MMP inhibitor-was developed. Several CH-DOX hydrogel formulations were characterized for their mechanical and sclerosing properties, injectability, DOX release rate, and MMP inhibition. An optimized formulation was assessed for its short-term ability to occlude blood vessels in vivo. All formulations were injectable and gelled rapidly at body temperature. Only hydrogels prepared with 0.075M sodium bicarbonate and 0.08M phosphate buffer as the gelling agent presented sufficient mechanical properties to immediately impede physiological flow. DOX release from this gel was in a two-stage pattern: a burst release followed by a slow continuous release. Released DOX was bioactive and able to inhibit MMP-2 activity in human glioblastoma cells. Preliminary in vivo testing in pig renal arteries showed immediate and delayed embolization success of 96% and 86%, respectively. Altogether, CH-DOX hydrogels appear to be promising new multifunctional embolic agents for the treatment of endoleaks. STATEMENT OF SIGNIFICANCE An injectable embolizing chitosan hydrogel releasing doxycycline (DOX) was developed as the first multi-faceted approach for the occlusion of blood vessels. It combines occlusive properties with DOX sclerosing and MMP inhibition properties, respectively known to prevent recanalization process and to counteract the underlying pathophysiology of vessel wall degradation and aneurysm progression. After drug release, the biocompatible scaffold can be invaded by cells and slowly degrade. Local DOX delivery requires lower drug amount and decreases risks of side effects compared to systemic administration. This new gel could be used for the prevention or treatment of endoleaks after endovascular aneurysm repair, but also for the embolization of other blood vessels such as venous or vascular malformations.
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Marcelin C, Izaaryene J, Castelli M, Barral PA, Jacquier A, Vidal V, Bartoli JM. Embolization of ovarian vein for pelvic congestion syndrome with ethylene vinyl alcohol copolymer (Onyx ®). Diagn Interv Imaging 2017. [PMID: 28647478 DOI: 10.1016/j.diii.2017.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of pelvic embolization using ethylene vinyl alcohol copolymer (Onyx®) for pelvic congestion syndrome. MATERIAL AND METHODS Between March 2012 to September 2016, 17 women (mean age, 44.7± 12.2 (SD) years; range: 34-71years) presenting with pelvic congestion syndrome were evaluated for transvenous embolization with Onyx®. Pelvic congestion syndrome was initially diagnosed by clinical examination and the results of transvaginal Doppler ultrasound and further confirmed by pelvic venography. Primary and secondary clinical efficacy was defined respectively by the resolution of the symptoms after embolization and at the end of the follow-up, irrespective to the number of embolization procedures. RESULTS Technical efficacy of embolization was 100% with no significant complications during and after embolization. After a mean follow-up time of 24.2 months (range: 6-69months) a primary and secondary clinical efficacy of 76.4% (13/17 women) and 94.1% (16/17 women) respectively were observed. Four women (23.5%) underwent a second embolization procedure with one woman requiring a third embolization procedure. These additional embolization procedures were associated with direct puncture of vulvar varices for sclerotherapy in two women. Five women (29%) had recurrent symptoms 21 months post-treatment (7-42months). CONCLUSION Pelvic embolization using ethylene vinyl alcohol copolymer (Onyx®) has a favorable clinical success for pelvic congestion syndrome.
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Affiliation(s)
- C Marcelin
- Department of Medical Imaging, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - J Izaaryene
- Department of Medical Imaging, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - M Castelli
- Department of Medical Imaging, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - P A Barral
- Department of Medical Imaging, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - A Jacquier
- Department of Medical Imaging, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - V Vidal
- Department of Medical Imaging, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - J M Bartoli
- Department of Medical Imaging, hôpital de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
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12
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Chitosan–Sodium Tetradecyl Sulfate Hydrogel: Characterization and Preclinical Evaluation of a Novel Sclerosing Embolizing Agent for the Treatment of Endoleaks. Cardiovasc Intervent Radiol 2017; 40:576-584. [DOI: 10.1007/s00270-016-1557-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/22/2016] [Indexed: 11/26/2022]
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13
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Poursaid A, Jensen MM, Huo E, Ghandehari H. Polymeric materials for embolic and chemoembolic applications. J Control Release 2016; 240:414-433. [PMID: 26924353 PMCID: PMC5001944 DOI: 10.1016/j.jconrel.2016.02.033] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 02/19/2016] [Accepted: 02/21/2016] [Indexed: 12/18/2022]
Abstract
Percutaneous transcatheter embolization procedures involve the selective occlusion of blood vessels. Occlusive agents, referred to as embolics, vary in material characteristics including chemical composition, mechanical properties, and the ability to concurrently deliver drugs. Commercially available polymeric embolics range from gelatin foam to synthetic polymers such as poly(vinyl alcohol). Current systems under investigation include tunable, bioresorbable microspheres composed of chitosan or poly(ethylene glycol) derivatives, in situ gelling liquid embolics with improved safety profiles, and radiopaque embolics that are trackable in vivo. This article reviews commercially available materials used for embolization as well as polymeric materials that are under investigation.
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Affiliation(s)
- Azadeh Poursaid
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA; Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT 84112, USA
| | - Mark Martin Jensen
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA; Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT 84112, USA
| | - Eugene Huo
- Veterans Affairs Hospital, Salt Lake City, UT 84108, USA
| | - Hamidreza Ghandehari
- Department of Bioengineering, University of Utah, Salt Lake City, UT 84112, USA; Center for Nanomedicine, Nano Institute of Utah, University of Utah, Salt Lake City, UT 84112, USA; Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT 84112, USA.
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14
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Ribé L, Bicknell CD, Gibbs RG, Burfitt N, Jenkins MP, Cheshire N, Hamady M. Long-term results of intra-arterial onyx injection for type II endoleaks following endovascular aneurysm repair. Vascular 2016; 25:266-271. [DOI: 10.1177/1708538116671467] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The aim of this paper is to report our experience of type II endoleak treatment after endovascular aneurysm repair with intra-arterial injection of the embolizing liquid material, Onyx liquid embolic system. Methods From 2005 to 2012, we performed a retrospective review of 600 patients, who underwent endovascular repair of an abdominal aortic aneurysm. During this period, 18 patients were treated with Onyx for type II endoleaks. Principal findings The source of the endoleak was the internal iliac artery in seven cases, inferior mesenteric artery in seven cases and lumbar arteries in four cases. Immediate technical success was achieved in all patients and no endoleak from the treated vessel recurred. During a mean follow-up of 19 months, no major morbidity or mortality occurred, and one-year survival was 100%. Conclusions Treatment of type II endoleaks with Onyx is safe and effective over a significant time period.
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Affiliation(s)
- L Ribé
- Imperial Vascular Unit, St. Mary’s Hospital, Imperial College London NHS Trust, London, UK
| | - CD Bicknell
- Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Vascular Unit, Imperial College London NHS Trust, London, UK
| | - RG Gibbs
- Imperial Vascular Unit, St. Mary’s Hospital, Imperial College London NHS Trust, London, UK
| | - N Burfitt
- Imperial Vascular Unit, St. Mary’s Hospital, Imperial College London NHS Trust, London, UK
| | - MP Jenkins
- Imperial Vascular Unit, St. Mary’s Hospital, Imperial College London NHS Trust, London, UK
| | - N Cheshire
- Department of Interventional Radiology, St. Mary’s Hospital, Imperial Vascular Unit, Imperial College London NHS Trust, London, UK
| | - M Hamady
- Department of Interventional Radiology, St. Mary’s Hospital, Imperial Vascular Unit, Imperial College London NHS Trust, London, UK
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15
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Lind BB, Briggs CS, Golan J, Gupta N. Embolization of Onyx Causing Acute Limb Ischemia. Ann Vasc Surg 2016; 38:320.e5-320.e8. [PMID: 27554697 DOI: 10.1016/j.avsg.2016.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 05/26/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
Abstract
We present the case of a patient with a refractory type II endoleak treated with translumbar Onyx with passage of the Onyx material into the endograft and subsequent embolization to the infrainguinal vasculature. This report represents a new complication of Onyx embolization that, to our knowledge, has not previously been described in the literature.
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Affiliation(s)
- Benjamin B Lind
- Division of Vascular Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - Charles S Briggs
- Division of Vascular Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - John Golan
- Division of Vascular Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL
| | - NavYash Gupta
- Division of Vascular Surgery, Department of Surgery, NorthShore University HealthSystem, Evanston, IL.
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16
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Chaer RA, DeRubertis BG, Trocciola S, Hynecek R, Lin SC, Lam R, Kent KC, Faries PL. Basic Science Review: Characterization of Endoleak Following Endovascular Repair of Abdominal Aortic Aneurysms. Vasc Endovascular Surg 2016; 41:97-105. [PMID: 17463197 DOI: 10.1177/1538574406297252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aneurysm models have been developed to study the pathobiology of abdominal aortic aneurysm and to evaluate the efficacy of endovascular therapy. The purpose of this review is to describe the use and limitations of current animal and experimental models for the characterization of endoleak following endovascular repair of abdominal aortic aneurysms.
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Affiliation(s)
- Rabih A Chaer
- Weill Medical College of Cornell University, New York, New York 10021, USA
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17
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Zanchetta M, Faresin F, Pedon L, Ronsivalle S. Intraoperative Intrasac Thrombin Injection to Prevent Type II Endoleak after Endovascular Abdominal Aortic Aneurysm Repair. J Endovasc Ther 2016; 14:176-83. [PMID: 17484533 DOI: 10.1177/152660280701400209] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To report a prospective, nonrandomized pilot study to determine whether fibrin glue aneurysm sac embolization at the time of endovascular aneurysm repair (EVAR) is a safe and effective procedure to primarily prevent type II endoleaks. Methods: Between June 2003 and December 2005, 84 consecutive patients (79 men; mean age 73.8±7.8 years, range 64–86) with degenerative infrarenal abdominal aortic aneurysm underwent EVAR with bifurcated stent-grafts and fibrin glue injection into the aneurysm sac at the conclusion of the endovascular procedure. A total of 424 imaging studies and 348 visits were recorded during the study period and reviewed. Results: Selective catheterization of the aneurysm sac and fibrin glue injection immediately after initial stent-graft deployment was successful in 83 (99%) of 84 cases; there was one failure to access the excluded aneurysm sac due to severe iliac artery calcification. The estimated primary and assisted clinical success rates at 2 years were 91.3% and 98.8%, respectively, but the major findings were the low rate of delayed type II endoleak (2.4%) and the statistically significant decrease in the maximum transverse aneurysm diameter (50.40±6.70 versus 42.03±6.50 mm, p=0.0001) at follow-up. In addition, of 31 patients available for 24-month follow-up, 14 (45.2%) patients showed a reduction in maximum transverse aneurysm diameter by ≥5 mm; 16 (51.6%) patients had no significant changes, whereas only 1 patient showed a >5-mm enlargement. Conclusion: This clot engineering approach to aneurysm sac embolization at the time of endografting appears to be safe and may spare the patient a repeated catheter-based intervention or surgical procedure.
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Affiliation(s)
- Mario Zanchetta
- Department of Cardiovascular Disease, Cittadella, Padua, Italy.
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18
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Barleben A, Inui T, Owens E, Lane JS, Bandyk DF. Intervention after endovascular aneurysm repair: Endosalvage techniques including perigraft arterial sac embolization and endograft relining. Semin Vasc Surg 2016; 29:41-49. [PMID: 27823589 DOI: 10.1053/j.semvascsurg.2016.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Endovascular aneurysm repair (EVAR) has revolutionized the treatment of abdominal aortic aneurysm (AAA). However, persistent AAA sac endoleak following EVAR can result in sac diameter increase requiring re-intervention in up to one-third of cases and even result in aneurysm rupture. In this case review, we summarize and detail endovascular re-interventions for each type of endoleak. We also detail specific options including stent-graft relining for indeterminate, Type III, and Type IV endoleaks and perigraft arterial sac embolization to induce thrombosis and resolve acute Type I, II, or III endoleaks. Endograft relining involves placement of a new stent-graft-elevating the bifurcation and extending the repair from renal artery to hypogastric arteries; perigraft arterial sac embolization involves placement of a catheter into the excluded sac from common femoral artery access, characterization of the inflow and outflow of the endoleak, and inducing cessation of the blood flow into the sac by the administration of thrombogenic material. Endoleaks range from low-pressure endoleaks, which can be safely monitored in a surveillance program to high-pressure endoleaks, which mandate intervention when associated with AAA sac diameter increase to protect from rupture. The evaluation of new devices and techniques to treat endoleak after EVAR remains an important issue in patient care after EVAR.
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Affiliation(s)
- Andrew Barleben
- Division of Vascular and Endovascular Surgery, Sulpizio Cardiovascular Center, University of California-San Diego School of Medicine, 9434 Medical Center Drive, Mail Code 7403, La Jolla, CA 92037; Department of Surgery, Division of Vascular Surgery, San Diego Veteran's Administration, La Jolla, CA.
| | - Tazo Inui
- Division of Vascular and Endovascular Surgery, Sulpizio Cardiovascular Center, University of California-San Diego School of Medicine, 9434 Medical Center Drive, Mail Code 7403, La Jolla, CA 92037; Department of Surgery, Division of Vascular Surgery, San Diego Veteran's Administration, La Jolla, CA
| | - Erik Owens
- Department of Surgery, Division of Vascular Surgery, San Diego Veteran's Administration, La Jolla, CA
| | - John S Lane
- Division of Vascular and Endovascular Surgery, Sulpizio Cardiovascular Center, University of California-San Diego School of Medicine, 9434 Medical Center Drive, Mail Code 7403, La Jolla, CA 92037; Department of Surgery, Division of Vascular Surgery, San Diego Veteran's Administration, La Jolla, CA
| | - Dennis F Bandyk
- Division of Vascular and Endovascular Surgery, Sulpizio Cardiovascular Center, University of California-San Diego School of Medicine, 9434 Medical Center Drive, Mail Code 7403, La Jolla, CA 92037; Department of Surgery, Division of Vascular Surgery, San Diego Veteran's Administration, La Jolla, CA
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19
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Evidence for Ethylene-Vinyl-Alcohol-Copolymer Liquid Embolic Agent as a Monotherapy in Treatment of Endoleaks. Eur J Vasc Endovasc Surg 2016; 51:810-4. [DOI: 10.1016/j.ejvs.2016.02.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 02/17/2016] [Indexed: 12/19/2022]
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20
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Embolization biomaterial reinforced with nanotechnology for an in-situ release of anti-angiogenic agent in the treatment of hyper-vascularized tumors and arteriovenous malformations. Eur J Pharm Biopharm 2015; 96:396-408. [DOI: 10.1016/j.ejpb.2015.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/08/2015] [Accepted: 09/09/2015] [Indexed: 12/28/2022]
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21
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Ameli-Renani S, Pavlidis V, Mailli L, Turner P, Morgan RA. Transiliac Paraendograft Embolisation of Type 2 Endoleak: An Alternative Approach for Endoleak Management. Cardiovasc Intervent Radiol 2015; 39:279-83. [DOI: 10.1007/s00270-015-1203-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/11/2015] [Indexed: 11/29/2022]
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22
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Choong AM, Mitchell K, Jenkins J. A Right Intercosto-Bronchial Artery Derived from the Thyrocervical Trunk: An Unusual Cause of Type II Endoleak Post Thoracic Aortic Stenting. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:139-41. [PMID: 25883899 PMCID: PMC4398162 DOI: 10.5090/kjtcs.2015.48.2.139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/18/2014] [Accepted: 09/23/2014] [Indexed: 11/16/2022]
Abstract
The aetiology, incidence and management of type II endoleaks in standard infrarenal endovascular aortic aneurysm repair is well described. Far less data is available for thoracic stent grafting. We present a rare and interesting case of a type II endoleak post thoracic aortic stenting and highlight the aberrant anatomy that can cause this phenomenon in such cases.
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Affiliation(s)
- Andrew Mtl Choong
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital ; Department of Surgery, University of Queensland, Brisbane ; Department of Surgery, Griffith University
| | - Ken Mitchell
- Department of Interventional Radiology, Royal Brisbane and Women's Hospital
| | - Jason Jenkins
- Department of Vascular Surgery, Royal Brisbane and Women's Hospital
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23
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Chung R, Morgan RA. Type 2 Endoleaks Post-EVAR: Current Evidence for Rupture Risk, Intervention and Outcomes of Treatment. Cardiovasc Intervent Radiol 2014; 38:507-22. [PMID: 25189665 DOI: 10.1007/s00270-014-0987-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/26/2014] [Indexed: 10/24/2022]
Abstract
Type 2 endoleaks (EL2) are the most commonly encountered endoleaks following EVAR. Despite two decades of experience, there remains considerable variation in the management of EL2 with controversies ranging from if to treat, when to treat and how to treat. Here, we summarise the available evidence, describe the treatment techniques available and offer guidelines for management.
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Affiliation(s)
- Raymond Chung
- Radiology, Ground Floor, St. James Wing, St. George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, England, UK,
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24
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Quinones-Baldrich W, Levin ES, Lew W, Barleben A. Intraprocedural and postprocedural perigraft arterial sac embolization (PASE) for endoleak treatment. J Vasc Surg 2014; 59:538-41. [DOI: 10.1016/j.jvs.2013.07.104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 07/21/2013] [Accepted: 07/23/2013] [Indexed: 11/30/2022]
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25
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Reinterventions for Type 2 Endoleaks with Enlargement of the Aneurismal Sac after Endovascular Treatment of Abdominal Aortic Aneurysms. Ann Vasc Surg 2014; 28:192-200. [DOI: 10.1016/j.avsg.2012.10.038] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 10/01/2012] [Accepted: 10/04/2012] [Indexed: 11/19/2022]
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26
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Abstract
CLINICAL/METHODICAL ISSUE Liquid embolic agents are used for permanent occlusion of capillaries but optimal administration properties are lacking. STANDARD RADIOLOGICAL METHODS The lack of visualization by fluoroscopy and the risk of serious complications are disadvantages of conventional embolic agents, such as ethanol and Histoacryl. METHODICAL INNOVATIONS Onyx is a liquid embolic agent consisting of ethylene vinyl alcohol copolymer dissolved in various concentrations of dimethyl sulfoxide (DMSO) and suspended micronized tantalum powder to provide contrast for fluoroscopy. PERFORMANCE The physicochemical characteristics of Onyx allow controlled application, forming a defined cast and permanent occlusion. Disadvantages are the high costs. Furthermore, the solvent DMSO requires special catheter material and causes pain during Onyx application. ACHIEVEMENTS Onyx has been primarily used for interventional neuroradiological treatment but peripheral applications are becoming increasingly more common. PRACTICAL RECOMMENDATIONS Currently, Onyx is mainly used for embolotherapy of endoleaks after endovascular aortic aneurysm repair, for treatment of acute arterial bleeding and for treatment of arteriovenous malformations.
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Affiliation(s)
- W A Wohlgemuth
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 1, Regensburg, Germany.
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27
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Abstract
Abstract
Background
The aim was to assess the risk of rupture, and determine the benefits of intervention for the treatment of type II endoleak after endovascular abdominal aortic aneurysm repair (EVAR).
Methods
This systematic review was done according to PRISMA guidelines. Outcome data included incidence, spontaneous resolution, sac expansion, interventions, clinical success, and complications including conversion to open repair, and rupture.
Results
Thirty-two non-randomized retrospective studies were included, totalling 21 744 patients who underwent EVAR. There were 1515 type II endoleaks and 393 interventions. Type II endoleak was seen in 10·2 per cent of patients after EVAR; 35·4 per cent resolved spontaneously. Fourteen patients (0·9 per cent) with isolated type II endoleak had ruptured abdominal aortic aneurysm; six of these did not have known aneurysm sac expansion. Of 393 interventions for type II endoleak, 28·5 per cent were unsuccessful. Translumbar embolization had a higher clinical success rate than transarterial embolization (81 versus 62·5 per cent respectively; P = 0·024) and fewer recurrent endoleaks were reported (19 versus 35·8 per cent; P = 0·036). Transarterial embolization also had a higher rate of complications (9·2 per cent versus none; P = 0·043).
Conclusion
Aortic aneurysm rupture after EVAR secondary to an isolated type II endoleak is rare (less than 1 per cent), but over a third occur in the absence of sac expansion. Translumbar embolization had a higher success rate with a lower risk of complications.
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28
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Khaja MS, Park AW, Swee W, Evans AJ, Fritz Angle J, Turba UC, Sabri SS, Matsumoto AH. Treatment of Type II Endoleak Using Onyx With Long-Term Imaging Follow-Up. Cardiovasc Intervent Radiol 2013; 37:613-22. [DOI: 10.1007/s00270-013-0706-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 06/22/2013] [Indexed: 10/26/2022]
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29
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Karaman K, Dokdok AM, Karadeniz O. CT- and Fluoroscopy-Guided Percutaneous Transabdominal Embolization of Type II Endoleak. Eurasian J Med 2013; 45:132-4. [PMID: 25610266 DOI: 10.5152/eajm.2013.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 03/02/2013] [Indexed: 11/22/2022] Open
Abstract
We report a case of a 79-year-old male patient who was treated 3 years previously at another hospital for an abdominal aortic aneurysm with a maximal diameter of 80 mm. After the treatment control period, computed tomography imaging revealed a type II endoleak and no progression in the size of the aneurysm sac. Selective injection of the superior mesenteric artery revealed that the endoleak was filled by the inferior mesenteric artery via the marginal artery. However, it was not possible to access using retrograde catheterization. We decided to treat the type II endoleak percutaneously. Embolization was performed at the tomography table using fluoroscopy with a mobile C-arm, and the puncture was performed transabdominally because there was no access to the sac via a translumbar approach. Under fluoroscopic guidance, various diameter/length coils were deployed. Follow-up computed tomography scans confirmed the collapsed aneurysm sac. When other conventional endovascular methods have failed, percutaneous transabdominal treatment of a type II endoleak with sac enlargement offers an alternative treatment method.
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Affiliation(s)
- Kutlay Karaman
- Department of Radiology, Anadolu Medical Center, Kocaeli, Turkey
| | - A Murat Dokdok
- Department of Radiology, Anadolu Medical Center, Kocaeli, Turkey
| | - Oktay Karadeniz
- Department of Radiology, Anadolu Medical Center, Kocaeli, Turkey
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Transarterial Embolization of Type II Endoleaks after EVAR: The Role of Ethylene Vinyl Alcohol Copolymer (Onyx). Cardiovasc Intervent Radiol 2013; 36:1288-95. [DOI: 10.1007/s00270-013-0567-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 12/30/2012] [Indexed: 11/25/2022]
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31
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Coutu JM, Fatimi A, Berrahmoune S, Soulez G, Lerouge S. A new radiopaque embolizing agent for the treatment of endoleaks after endovascular repair: Influence of contrast agent on chitosan thermogel properties. J Biomed Mater Res B Appl Biomater 2012; 101:153-61. [DOI: 10.1002/jbm.b.32828] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 06/26/2012] [Accepted: 08/20/2012] [Indexed: 11/08/2022]
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32
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Guimaraes M, Wooster M. Onyx (Ethylene-vinyl Alcohol Copolymer) in Peripheral Applications. Semin Intervent Radiol 2012; 28:350-6. [PMID: 22942553 DOI: 10.1055/s-0031-1284462] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Onyx is a nonadhesive liquid embolic agent approved for the treatment of brain arteriovenous malformations. Here, the use of Onyx is discussed in different peripheral procedures. The Onyx's features, its manipulation, technical details, tips, and tricks are presented followed by illustrative cases.
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33
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Fatimi A, Chabrot P, Berrahmoune S, Coutu JM, Soulez G, Lerouge S. A new injectable radiopaque chitosan-based sclerosing embolizing hydrogel for endovascular therapies. Acta Biomater 2012; 8:2712-21. [PMID: 22487932 DOI: 10.1016/j.actbio.2012.04.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 03/16/2012] [Accepted: 04/02/2012] [Indexed: 12/17/2022]
Abstract
Endovascular repair of abdominal aortic aneurysms with a stent graft is limited by the persistence or recurrence of endoleaks. These are believed to be related to the recanalization of the aneurismal sac by endothelialized neochannels, which could lead to late type I and II endoleaks. Embolization has been proposed to treat or prevent endoleaks, but presently commercialized embolizing materials have several drawbacks and do not fully prevent endoleak recurrence. A novel chitosan hydrogel that is injectable, radiopaque and contains sodium tetradecyl sulfate (STS), a well-known sclerosing agent, was developed in order to combine blood flow occlusion and endothelium ablation properties. chitosan/STS hydrogels were characterized and optimized using rheometry, scanning electron microscopy, swelling and ex vivo embolization assay. They were shown to exhibit rapid gelation and good mechanical properties, as well as sclerosing properties. Their potential for the embolization of aneurysms was subjected to preliminary in vivo evaluation in a bilateral iliac aneurysm model (three dogs) reproducing persistent endoleaks after endovascular aneurysm repair (EVAR). At 3 months no endoleak was detected in any of the three aneurysms treated with chitosan/STS hydrogels. In contrast, type I endoleaks were detected in two of the three aneurysms treated with chitosan hydrogels. Generally, chitosan/STS hydrogels have great potential as embolizing and sclerosing agents for EVAR and possibly other endovascular therapies.
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Affiliation(s)
- Ahmed Fatimi
- École de technologie supérieure, Department of Mechanical Engineering, Montréal, Québec, Canada
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34
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Funaki B, Birouti N, Zangan SM, Van Ha TG, Lorenz JM, Navuluri R, Skelly CL, Leef JA. Evaluation and treatment of suspected type II endoleaks in patients with enlarging abdominal aortic aneurysms. J Vasc Interv Radiol 2012; 23:866-72; quiz 872. [PMID: 22609291 DOI: 10.1016/j.jvir.2012.04.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 04/02/2012] [Accepted: 04/04/2012] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To evaluate angiographic diagnosis and embolotherapy of patients with enlarging abdominal aortic aneurysms and computed tomographic (CT) diagnosis of type II endoleak. MATERIALS AND METHODS A retrospective review was performed of all patients referred to a single vascular and interventional radiology section from January 1, 2003, to June 1, 2011, with a diagnosis of enlarging aneurysm and type II endoleak. Twenty-five patients underwent 40 procedures between 12 and 82 months after endograft insertion (mean, 48 mo) for diagnosis and/or treatment of endoleaks. RESULTS Type II endoleaks were treated with cyanoacrylate, coils, and ethylene vinyl alcohol copolymer in 16 patients. Technical success rate was 88% (14 of 16 patients) and clinical success rate was 100% (16 of 16 patients). Aneurysm growth was arrested in all cases over a mean follow-up of 27.5 months (range, 6-88 mo). Endoleaks in nine patients were misclassified on CT; two had type I endoleaks and seven had type III endoleaks. Four of the nine patients (two type I endoleaks and two type III endoleaks) were correctly classified after initial angiography. The other five type III endoleaks were correctly classified on CT after coil embolization of the inferior mesenteric artery. Direct embolization was performed via sac puncture with ethylene vinyl alcohol copolymer in two of the latter five patients and eliminated endoleaks in both. CONCLUSIONS Aneurysm growth caused by type II endoleaks was arrested by embolization. CT misclassification occurred relatively commonly; type III endoleaks purported to be type II endoleaks were found in 28% of patients (seven of 25).
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Affiliation(s)
- Brian Funaki
- Section of Vascular and Interventional Radiology, Department of Radiology, University of Chicago Medical Center, 5840 S. Maryland Ave., MC 2026, Chicago, IL 60637, USA.
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Massis K, Carson WG, Rozas A, Patel V, Zwiebel B. Treatment of Type II Endoleaks With Ethylene-Vinyl-Alcohol Copolymer (Onyx). Vasc Endovascular Surg 2012; 46:251-7. [DOI: 10.1177/1538574412442401] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report our single-center experience in treating 101 type II endoleaks with ethylene-vinyl-alcohol copolymer (EVOH, Onyx). In all, 65 endoleaks were embolized transarterially, and 36 were treated through a translumbar approach. Since the first transarterial embolization, when we began attempts to treat all patients initially via common femoral access, 58 (65.9%) of 88 patients were successfully embolized transarterially. All endoleaks in the translumbar group were successfully treated. At a median follow-up length of 15 weeks, a decrease or stabilization in aneurysm size was observed in 39 (73.6%) of the 53 endoleaks that had adequate follow-up computed tomography imaging. The overall residual endoleak rate was 34.0%. There was no difference in efficacy when comparing transarterial and translumbar approaches. We demonstrate that in most cases, transarterial access of the endoleak nidus is feasible, and controlled embolization is possible using EVOH. Furthermore, EVOH appears effective in long-term stabilization of aneurysm size and in preventing residual endoleaks.
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Affiliation(s)
- Kamal Massis
- Florida Interventional Specialists, Tampa, FL, USA
- University of South Florida College of Medicine, Tampa, FL, USA
| | | | - Alexandra Rozas
- University of South Florida College of Medicine, Tampa, FL, USA
| | - Vishal Patel
- University of South Florida College of Medicine, Tampa, FL, USA
| | - Bruce Zwiebel
- Florida Interventional Specialists, Tampa, FL, USA
- University of South Florida College of Medicine, Tampa, FL, USA
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Sucandy I, Kim H, Sullivan TR. Endovascular management of the patent inferior mesenteric artery in two cases of uncontrolled type II endoleak after endovascular aneurysm repair. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2011; 3:387-90. [PMID: 22171248 PMCID: PMC3234148 DOI: 10.4297/najms.2011.3387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Context: Endovascular aneurysm repair (EVAR) has well documented advantages over traditional open repair and has been widely adopted as the alternative treatment modality for abdominal aortic aneurysm. However, endoleaks specifically type II can be a significant problem with this technique leading to aortic sac expansion and potential rupture. A large number of type II endoleaks are caused by persistent inferior mesenteric artery (IMA) retrograde bleeding. Various methods to try to manage this complication have been previously described. IMA embolization via the marginal artery of Drummond, however, has not been adequately popularized as an alternative less invasive approach to the treatment of type II endoleak. Case Report: Two men, ages 77 and 81, underwent uneventful EVAR for 5.5 and 5.0 cm infrarenal abdominal aortic aneurysms, respectively, using Zenith Cook® bifurcated stent grafts. Computed tomography angiography at 1 and 6 months postoperatively demonstrated small type II endoleaks in both cases which were followed clinically. Subsequent follow-up tomography scan at 12 months revealed persistent type II endoleaks related to retrograde filling from the IMA with significant enlargement of the aneurysm sacs. Both patients underwent successful IMA coil embolization via the marginal artery of Drummond. Conclusions: Percutaneous IMA embolization using standard endovascular techniques to access the marginal artery of Drummond is an alternative, and in our opinion, preferred technique for controlling type II endoleaks caused by a persistently patent IMA.
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Affiliation(s)
- Iswanto Sucandy
- Department of Surgery, Abington Memorial Hospital, Abington, Pennsylvania, USA
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Lerouge S, Bonneviot MC, Salazkin I, Raymond J, Soulez G. Endothelial Denudation Combined With Embolization in the Prevention of Endoleaks After Endovascular Aneurysm Repair:An Animal Study. J Endovasc Ther 2011; 18:686-96. [DOI: 10.1583/11-3541.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Wilmot A, Stavropoulos SW. Embolization of a Recurrent Type 2 Endoleak Using the Liquid Embolic n-Butyl Cyanoacrylate. Semin Intervent Radiol 2011; 24:38-42. [PMID: 21326734 DOI: 10.1055/s-2007-971187] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endovascular aneurysm repair (EVAR) has become an accepted alternative to open aortic aneurysm repair. Endoleaks are one of the most common complications of EVAR and can result in aneurysm enlargement and rupture. When embolization of type 2 endoleaks is needed, a transarterial or translumbar approach may be used. Metal coils are often utilized, but liquid agents have also been used for embolization. This case report involves endoleak embolization using metallic coils along with the liquid embolic agent n-butyl cyanoacrylate (n-BCA).
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Affiliation(s)
- Andrew Wilmot
- Department of Radiology, Division of Interventional Radiology, Hospital of University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Embolization with Onyx in Iatrogenic Bleeding of the Gluteal Region. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011; 6:267-70. [DOI: 10.1097/imi.0b013e31822afbe9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report a unique method using transcatheter Onyx embolization in a bleeding due to morphine injection in the gluteal region. A 47-year-old man with a rare blood type presented a painful gluteal hematoma due to iatrogenic injury. A computed tomographic angiography verified bleeding from a suspected branch of the deep femoral artery. Because of the unbearable pain, the hematoma was evacuated by means of computed tomography (CT)-guided puncture and the insertion of a pigtail catheter combined with the injection of a human plasminogen activation agent (t-PA). The initial result was positive. To stop the bleeding, angiographic embolization with Onyx was successfully used. Onyx can be used in small vessel bleedings and might offer the advantage of selective embolization in cases where the access to the bleeding vessel is challenging or time-consuming.
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Hörer T, Toivola A, Larzon T. Embolization with Onyx in Iatrogenic Bleeding of the Gluteal Region. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2011. [DOI: 10.1177/155698451100600412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Tal Hörer
- Department of Surgery, Örebro University Hospital, Örebro, Sweden
| | - Asko Toivola
- Department of Surgery, Örebro University Hospital, Örebro, Sweden
| | - Thomas Larzon
- Department of Surgery, Örebro University Hospital, Örebro, Sweden
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Müller-Wille R, Heiss P, Herold T, Jung EM, Schreyer AG, Hamer OW, Rennert J, Hoffstetter P, Stroszczynski C, Zorger N. Endovascular Treatment of Acute Arterial Hemorrhage in Trauma Patients Using Ethylene Vinyl Alcohol Copolymer (Onyx). Cardiovasc Intervent Radiol 2011; 35:65-75. [DOI: 10.1007/s00270-011-0134-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Accepted: 02/15/2011] [Indexed: 10/18/2022]
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Choi SY, Lee DY, Lee KH, Ko YG, Choi D, Shim WH, Won JY. Treatment of Type I Endoleaks after Endovascular Aneurysm Repair of Infrarenal Abdominal Aortic Aneurysm: Usefulness of N-butyl Cyanoacrylate Embolization in Cases of Failed Secondary Endovascular Intervention. J Vasc Interv Radiol 2011; 22:155-62. [DOI: 10.1016/j.jvir.2010.10.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 09/30/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022] Open
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Loffroy R, Kretz B, Guiu B, Bouchot O, Cercueil J, Brenot R, Krausé D, Steinmetz E. [Transabdominal percutaneous embolization of a type 2B endoleak in a patient with covered abdominal aortic endoprosthesis]. JOURNAL DE RADIOLOGIE 2010; 91:901-904. [PMID: 20814378 DOI: 10.1016/s0221-0363(10)70132-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Adams JD, Tracci MC, Sabri S, Cherry KJ, Angle JF, Matsumoto AH, Kern JA. Real-world experience with type I endoleaks after endovascular repair of the thoracic aorta. Am Surg 2010; 76:599-605. [PMID: 20583515 DOI: 10.1177/000313481007600623] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Endoleaks are a frequent complication of thoracic endovascular aortic repair (TEVAR) and will likely increase in incidence with application of the technique to more complicated aortic anatomy and a wider range of thoracic aortic pathologies. Management generally consists of aggressive repair of Type I endoleaks; however, the natural history of Type I endoleaks after TEVAR remains largely unknown. The purpose of this study was to examine the incidence and characteristics of Type I endoleaks and to evaluate clinical outcomes of patients with Type I endoleaks after TEVAR. A single-center retrospective review was performed on all patients who underwent TEVAR over a 4-year period. Type I endoleaks were detected in 21 per cent (27 of 129) of patients on post-deployment aortography or CT angiography. During a mean follow-up of 750.63 +/- 483 days, 59 per cent (16 of 27) closed spontaneously; 30 per cent (eight of 27) required secondary endovascular intervention; and 11 per cent (three of 27) have persisted with no increase in maximum aortic diameter. No patients have died or required open surgical conversion as a result of their Type I endoleak. Although accurate predictors of spontaneous resolution of Type I endoleaks have yet to be definitively characterized, our initial results suggest that it may be safe to observe small Type I endoleaks given that a large percentage resolve spontaneously and no endoleak-related deaths have occurred.
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Affiliation(s)
- Joshua D Adams
- Department of Radiology, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
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Lenhart M, Paetzel C, Sackmann M, Schneider H, Jung EM, Schreyer AG, Feuerbach S, Zorger N. Superselective arterial embolisation with a liquid polyvinyl alcohol copolymer in patients with acute gastrointestinal haemorrhage. Eur Radiol 2010; 20:1994-9. [PMID: 20379821 DOI: 10.1007/s00330-010-1762-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 01/08/2010] [Accepted: 02/12/2010] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the results of emergency embolisation in acute arterial bleeding of the gastrointestinal tract with a liquid polyvinyl alcohol copolymer from two centres. METHODS We retrospectively analysed 16 cases (15 patients) of acute arterial bleeding of the gastrointestinal tract where emergency embolotherapy was performed by using the copolymer when acute haemorrhage was not treatable with endoscopic techniques alone. Cause of haemorrhage and technical and clinical success were documented. RESULTS Arterial embolotherapy was successful in all 16 cases. The technical success rate was 100%. The cause of bleeding was pancreatitis in four, graft-versus-host disease (GVHD) of the colon in three, malignancy in three, angiodysplasia in two, ulcer in two and panarteritis nodosa and trauma in one each. There were no procedure-related complications. No bowel necrosis occurred because of embolisation. In 13 cases, the patients were discharged in good condition (81%); the three patients with GVHD died because of the underlying disease. CONCLUSIONS The copolymer seems to have great potential in embolotherapy of acute arterial gastrointestinal bleeding. In our series none of the patients had rebleeding at the site of embolisation and no clinically obvious bowel necrosis occurred.
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Affiliation(s)
- Markus Lenhart
- Department of Diagnostic and Interventional Radiology, Sozialstiftung Bamberg, Bamberg, Germany.
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Larzon T, Mathisen SR. Internal Sealing of Acute Aortic Bleeding with a Catheter-Delivered Liquid to Solid Embolic Agent (Onyx). Vascular 2010; 18:106-10. [DOI: 10.2310/6670.2010.00004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Occasionally, standard stent grafts are not usable in emergency aortic bleeding, and custom-made stent grafts are not practical as a replacement. We describe a novel technique for the repair of such aneurysms by using the catheter-delivered liquid to solid embolic agent Onyx (Micro Therapeutics Inc., Irvine, CA). Two patients with ruptured aortic aneurysm, where endovascular or open repair was not considered as feasible, were treated by internal sealing of the aneurysm with Onyx, resulting in stoppage of bleeding and further expansion of the aneurysm-the plugging and sealing technique.
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Affiliation(s)
- Thomas Larzon
- *Department of Surgery, Örebro University Hospital, Örebro, Sweden
| | - Sven R. Mathisen
- *Department of Surgery, Örebro University Hospital, Örebro, Sweden
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Choi SY, Won JY, Lee DY, Choi D, Shim WH, Lee KH. Percutaneous transabdominal approach for the treatment of endoleaks after endovascular repair of infrarenal abdominal aortic aneurysm. Korean J Radiol 2009; 11:107-14. [PMID: 20046501 PMCID: PMC2799639 DOI: 10.3348/kjr.2010.11.1.107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2009] [Accepted: 10/30/2009] [Indexed: 11/15/2022] Open
Abstract
Objective The purpose of this study was to evaluate the technical feasibility and clinical efficacy of percutaneous transabdominal treatment of endoleaks after endovascular aneurysm repair. Materials and Methods Between 2000 and 2007, six patients with type I (n = 4) or II (n = 2) endoleaks were treated by the percutaneous transabdominal approach using embolization with N-butyl cyanoacrylate with or without coils. Five patients underwent a single session and one patient had two sessions of embolization. The median time between aneurysm repair and endoleak treatment was 25.5 months (range: 0-84 months). Follow-up CT images were evaluated for changes in the size and shape of the aneurysm sac and presence or resolution of endoleaks. The median follow-up after endoleak treatment was 16.4 months (range: 0-37 months) Results Technical success was achieved in all six patients. Clinical success was achieved in four patients with complete resolution of the endoleak confirmed by follow-up CT. Clinical failure was observed in two patients. One eventually underwent surgical conversion, and the other was lost to follow-up. There were no procedure-related complications. Conclusion The percutaneous transabdominal approach for the treatment of type I or II endoleaks, after endovascular aneurysm repair, is an alternative method when conventional endovascular methods have failed.
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Affiliation(s)
- Sun Young Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, University of Yonsei, College of Medicine, Seoul 120-752, Korea
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Type II endoleak after endovascular repair of abdominal aortic aneurysm: effectiveness of embolization. Cardiovasc Intervent Radiol 2009; 33:278-84. [PMID: 19688365 DOI: 10.1007/s00270-009-9685-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 07/15/2009] [Accepted: 07/22/2009] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to report our experience in treating type II endoleaks after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms. Two hundred eighteen patients underwent EVAR with a Zenith stent-graft from January 2000 to December 2005. During a follow-up period of 4.5 + or - 2.3 years, solely type II endoleak was detected in 47 patients (22%), and 14 of them underwent secondary interventions to correct this condition. Ten patients had transarterial embolization, and four patients had translumbar/transabdominal embolization. The embolization materials used were coils, thrombin, gelatin, Onyx (ethylene-vinyl alcohol copolymer), and glue. Disappearance of the endoleak without enlargement of the aneurysm sac after the first secondary intervention was achieved in only five of these patients (5/13). One patient without surveillance imaging was excluded from analyses of clinical success. After additional interventions in four patients and the spontaneous disappearance of type II endoleak in two patients, overall clinical success was achieved in eight patients (8/12). One patient did not have surveillance imaging after the second secondary intervention. Clinical success after the first secondary intervention was achieved in two patients (2/9) in the transarterial embolization group and three patients (3/4) in the translumbar embolization group. The results of secondary interventions for type II endoleak are unsatisfactory. Although the small number of patients included in this study prevents reliable comparisons between groups, the results seem to favor direct translumbar embolization in comparison to transarterial embolization.
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Seron A, Moine L, Laurent A, Wassef M, Guiffant G, Flaud P, Labarre D. An embolic gelling solution based on acrylic copolymers in ethanol for the treatment of arteriovenous malformations. Biomaterials 2009; 30:3436-43. [DOI: 10.1016/j.biomaterials.2009.03.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 03/13/2009] [Indexed: 11/17/2022]
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