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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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2
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Massmann A, Fries P, Shayesteh-Kheslat R, Buecker A, Berg P, Frenzel F. Feasibility of aortic aneurysm sac embolization using a novel shape memory polymer embolic device. Eur Radiol Exp 2023; 7:12. [PMID: 37009937 PMCID: PMC10068687 DOI: 10.1186/s41747-023-00328-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/30/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND We investigated the feasibility of aneurysm sac embolization using a novel self-expanding porous shape memory polymer (SMP) device during endovascular aortic abdominal or thoracic aneurysm repair (EVAR). METHODS Retrospective analysis of consecutive patients treated at 2 centers in Germany. Patients were treated from January 2019 to July 2021 with follow-up at 7 days and 3, 6, and 12 months. Aneurysm sacs were implanted with SMP devices immediately following endograft placement during the same procedure. Primary endpoint was technically successful SMP-device deployment into the aneurysm sac outside the endograft. Secondary endpoints were changes in aneurysm volume and associated complications (e.g., endoleaks). RESULTS We included 18 patients (16 males), aged 72 ± 9 years, achieving 100% technical success. Mean preprocedure aortic aneurysm sac volume was 195 ± 117 mL with a perfused aneurysm volume of 97 ± 60 mL. A mean of 24 ± 12 SMP devices per patient were used (range 5-45, corresponding to 6.25-56.25 mL expanded embolic material volume). All evaluable patients exhibited sac regression except 2 patients yet to reach 3-month follow-up. At mean 11 ± 7 months (range 3-24), change in aneurysm volume from baseline was -30 ± 21 mL (p < 0.001). In 8 patients, aneurysm regression was observed despite type 2 endoleaks in 6 and type 1A endoleaks in 2, none of them requiring further intervention to date. No morbidity or mortality related to this treatment occurred. CONCLUSIONS SMP devices for aortic aneurysm sac embolization during endovascular repair appear feasible and safe in this small case series. Prospective studies are needed. KEY POINTS • Shape memory polymer is a novel, self-expanding, porous, and radiolucent embolic device material. • Aortic aneurysm sacs were treated with polymer devices immediately following endograft placement. • Aortic aneurysm sac regression was observed in all patients with over 3-month follow-up. • Aortic aneurysm sac regression was observed even in the presence of endoleaks.
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Affiliation(s)
- Alexander Massmann
- Radiology and Nuclear Medicine, Bosch Health Campus, Robert-Bosch-Krankenhaus, Auerbachstraße 110, 70376, Stuttgart, Germany.
| | - Peter Fries
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Roushanak Shayesteh-Kheslat
- Clinic for General, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Arno Buecker
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Patrick Berg
- Clinic for Vascular Surgery, Katholisches Karl-Leisner-Klinikum, Kevelaer, Germany
| | - Felix Frenzel
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
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Vance AZ, Graif A, Patel R, Chedrawy C, Chohan O, Garcia MJ, Kimbiris G, Leung DA. Outcome and technical evolution of type 2 endoleak embolization with ethylene-vinyl-alcohol copolymer. Vascular 2023; 31:10-17. [PMID: 35229689 DOI: 10.1177/17085381211053409] [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: 11/17/2022]
Abstract
PURPOSE This study aims to evaluate the safety and efficacy of novel approaches to type 2 endoleak access for the purpose of embolization using ethylene-vinyl-alcohol copolymer (EVOH) in patients with abdominal aortic aneurysm (AAA) sac expansion post endovascular abdominal aortic repair (EVAR). METHODS A retrospective review of 43 consecutive patients (mean age = 80.2 ± 6.7 years) who underwent 52 embolization procedures for type 2 endoleaks using EVOH was performed at a single institution. Catheterization of the endoleaks was achieved using the transarterial (TA) and direct translumbar approaches (DTL), in addition to the novel direct transabdominal (DTA) and perigraft (PG) approaches. Endpoints included technical success of endoleak catheterization, technical success of endoleak embolization, endoleak persistence, endoleak recurrence, AAA sac area change, and adverse events. RESULTS The TA, DTL, DTA, and PG approaches were used 25, 2, 14, and 19 times respectively, including nine procedures where a combination of approaches was used. The technical success rate of endoleak embolization was 98%. Five patients developed recurrent type 2 endoleaks, while five patients developed a type 1 endoleak. The persistent endoleak rate at a mean initial follow-up of 3 months was 34%. At a mean follow-up of 18 months, 58% of patients demonstrated absence of an endoleak, and 71% showed freedom from AAA sac enlargement. No major adverse events were recorded. CONCLUSION The DTA and PG approaches were safe and effective in this cohort of patients undergoing embolization of type 2 endoleaks with EVOH.
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Affiliation(s)
- Ansar Z Vance
- Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Assaf Graif
- Department of Vascular Interventional Radiology, Christiana Care Health System, Newark, DE, USA
| | - Ramkrishna Patel
- Department of Vascular Interventional Radiology, Albany Medical Center, Albany, NY, USA
| | - Christelle Chedrawy
- Department of Vascular Interventional Radiology, Christiana Care Health System, Newark, DE, USA
| | - Omar Chohan
- Great Lakes Medical Imaging, Buffalo, NY, USA
| | - Mark J Garcia
- Endovascular Consultants of Delaware, Wilmington, DE, USA
| | - George Kimbiris
- Department of Vascular Interventional Radiology, Christiana Care Health System, Newark, DE, USA
| | - Daniel A Leung
- Department of Vascular Interventional Radiology, Christiana Care Health System, Newark, DE, USA
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Nolte-Ernsting C, Mecklenbeck FP, Stehr A. Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer. ROFO : FORTSCHRITTE AUF DEM GEBIETE DER RONTGENSTRAHLEN UND DER NUKLEARMEDIZIN 2021; 193:1426-1435. [PMID: 34139782 DOI: 10.1055/a-1502-7883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Type 2 endoleaks (T2EL) are the most frequent complication following endovascular aortic repair. Multiple studies primarily deal with the technical and clinical success of the embolization of persisting T2EL, thereby revealing controversial outcomes. Current reports rarely focus on the detailed execution of such a complex interventional procedure with respect to the difficult anatomic setting. METHODS The present review provides an in-depth depiction and evaluation of the interventional methodology of the embolization of T2EL in the abdominal aorta with use of ethylene vinyl alcohol copolymer (EVOH). Complicating anatomic conditions are taken into account as well as technical and clinical success rates. RESULTS Using the transarterial approach, there are at least 4 different pathways to access the nidus of a T2EL. CT-guided direct puncture of the aneurysm sac provides an alternative method of high technical success. EVOH with its slow solidification characteristics enables good control to achieve complete filling of the T2EL. During the intervention, however, it remains difficult to meet exactly the embolization endpoint, especially in large T2ELs. CONCLUSION T2EL embolization using EVOH is an effective treatment with low major complication rates when conducted by skilled interventionists with detailed knowledge of diverse complex access routes. KEY POINTS · Many roads lead to Rome to access the nidus of a T2EL including diverse complex transarterial pathways and direct aneurysm sac puncture.. · Ethylene vinyl alcohol co-polymer enables good control for slow filling of the nidus with low risk of major complications.. · Identification of the embolization endpoint remains difficult during the procedure and may result in secondary interventions.. · Successful T2EL embolization requires detailed knowledge of all access routes to the nidus and skilled handling of liquid embolics.. CITATION FORMAT · Nolte-Ernsting C, Mecklenbeck F, Stehr A. Embolization of Type 2 Endoleaks in the Abdominal Aorta Using Ethylene Vinyl Alcohol Copolymer. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1502-7883.
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Affiliation(s)
- Claus Nolte-Ernsting
- Klinik für Diagnostische und Interventionelle Radiologie, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
| | - Frank-Peter Mecklenbeck
- Klinik für Diagnostische und Interventionelle Radiologie, Evangelisches Krankenhaus Mülheim an der Ruhr, Mülheim an der Ruhr, Germany
| | - Alexander Stehr
- Gefäßchirurgische Klinik, Evangelisches Krankenhaus Mülheim an der Ruhr, Germany
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Sapoval M, Vidal V, Déan C, Del Giudice C, Tradi F, Chevallier O, Charles-Nelson A, Pellerin O, Loffroy R. Safety and Efficacy of Peripheral Embolization with EASYX Liquid Embolic Agent: A Multicenter Prospective Study. J Vasc Interv Radiol 2021; 32:1136-1143. [PMID: 34098072 DOI: 10.1016/j.jvir.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the clinical safety and efficacy of EASYX, a new nonadhesive precipitating liquid embolic agent based on a polyvinyl alcohol ether polymer labeled with iodine molecules, for peripheral embolization. MATERIALS AND METHODS This open-label prospective multicenter study was conducted on 50 consecutive patients treated with embolization using EASYX in 3 academic hospitals from April 2018 to July 2019. Indications for embolization were symptomatic varicocele (n = 15), type II endoleak (n = 8), acute hemorrhage (n = 16), portal vein embolization (PVE; n = 9), or angiomyolipoma (AML; n = 2). Patient characteristics, technical and clinical success rates, pain at injection, and satisfaction of the interventional radiologists were assessed. Follow-up imaging was performed using ultrasound for varicoceles (at 1 month) and computed tomography (CT) for the other indications (at 3 or 6 months). RESULTS The immediate technical success rate was 98%. The clinical success rates were 100% for acute hemorrhage and type II endoleaks, 89% for PVE, 86% for varicoceles, and 50% for AMLs. Patients who underwent PVE showed significant hypertrophy of the future liver remnant at follow-up (P < .001), and 55.6% of patients proceeded to hepatectomy. The absence of artifacts on imaging allowed improved monitoring of the aneurysmal sac in patients with type II endoleaks. The satisfaction rate of the interventional radiologists was >90% for 5 of 7 items. CONCLUSIONS EASYX as a novel copolymer liquid embolic agent was safe and efficient for peripheral embolization. The absence of tantalum allowed reduced CT artifacts on imaging follow-up, which was especially useful in patients with type II endoleaks.
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Affiliation(s)
- Marc Sapoval
- Department of Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, PARCC, INSERM, Paris, France
| | - Vincent Vidal
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France; LiiE, Aix Marseille University, Marseille, France; CERIMED, Aix Marseille University, Marseille, France
| | - Carole Déan
- Department of Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France.
| | - Costantino Del Giudice
- Department of Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, PARCC, INSERM, Paris, France
| | - Farouk Tradi
- Interventional Radiology Section, Department of Medical Imaging, University Hospital Timone, AP-HM, Marseille, France; LiiE, Aix Marseille University, Marseille, France; CERIMED, Aix Marseille University, Marseille, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Anaïs Charles-Nelson
- Unité d'Épidémiologie et de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM, Centre d'Investigation Clinique 1418, module Épidémiologie Clinique, Paris, France
| | - Oliver Pellerin
- Department of Vascular and Oncological Interventional Radiology, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, PARCC, INSERM, Paris, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
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van Schaik TG, Meekel JP, Hoksbergen AWJ, de Vries R, Blankensteijn JD, Yeung KK. Systematic review of embolization of type I endoleaks using liquid embolic agents. J Vasc Surg 2021; 74:1024-1032. [PMID: 33940072 DOI: 10.1016/j.jvs.2021.03.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The long-term success of endovascular aneurysm repair (EVAR) is limited by complications, most importantly endoleaks. In case of (persistent) type I endoleak (T1EL), secondary intervention is indicated to prevent secondary aneurysm rupture. Different treatment options are suggested for T1ELs, such as endo anchors, (fenestrated) cuffs, embolization, or open conversion. Currently, the treatment of T1EL with liquid embolic agents is available; however, results are not yet addressed. This review presents the safety and efficacy of embolization with liquid embolic agents for treatment of T1ELs after EVAR. METHODS A systematic literature search was performed for all studies reporting the use of liquid embolic agents as monotherapy for treatment of T1ELs after EVAR. Patient numbers, technical success (successful delivery of liquid embolics in the T1EL) and clinical success (absence of aneurysm related death, endoleak recurrence or additional interventions during follow-up) were examined. RESULTS Of 1604 articles, 10 studies met the selection criteria, including 194 patients treated with liquid embolics; 73.2% of the patients were male with a median age of 71 years. The overall technical success was 97.9%. Clinical success was 87.6%. Because the median follow-up was only 13.0 months (range, 1-89 months), data on long-term success are almost absent. Four cases (2.1%) of secondary aneurysm rupture after embolization owing to endoleak recurrence were reported. All ruptures occurred in aneurysms exceeding initial treatment diameter of 70 mm. CONCLUSIONS Initial technical success after liquid embolization for T1EL is high, although long-term clinical success rates are lacking. Within this review, the risk of secondary rupture is comparable with untreated T1EL at 2% with a median follow-up of 13 months, regardless of the initial success of embolization. In general, no decrease in secondary aneurysm rupture after embolization of T1EL after EVAR is demonstrated, although the results of late embolization are debated.
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Affiliation(s)
- Theodorus G van Schaik
- Department of Vascular Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, Zaandam, The Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Location VUmc, Amsterdam, Zaandam, The Netherlands; Department of Surgery, Zaans Medisch Centrum, Zaandam The Netherlands
| | - Jorn P Meekel
- Department of Vascular Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, Zaandam, The Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Location VUmc, Amsterdam, Zaandam, The Netherlands; Department of Surgery, Zaans Medisch Centrum, Zaandam The Netherlands
| | - Arjan W J Hoksbergen
- Department of Vascular Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, Zaandam, The Netherlands
| | - Ralph de Vries
- Clinical Library, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Jan D Blankensteijn
- Department of Vascular Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, Zaandam, The Netherlands
| | - Kak K Yeung
- Department of Vascular Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, Zaandam, The Netherlands; Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Location VUmc, Amsterdam, Zaandam, The Netherlands.
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Gautier S, Chevallier O, Mastier C, d'Athis P, Falvo N, Pilleul F, Midulla M, Rat P, Facy O, Loffroy R. Portal vein embolization with ethylene-vinyl alcohol copolymer for contralateral lobe hypertrophy before liver resection: safety, feasibility and initial experience. Quant Imaging Med Surg 2021; 11:797-809. [PMID: 33532278 DOI: 10.21037/qims-20-808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background To report our preliminary experience with preoperative portal vein embolization (PVE) using liquid ethylene vinyl alcohol (EVOH) copolymer. Methods Retrospectively review of patients with primary or secondary liver malignancies scheduled for extensive hepatectomy after the induction of future liver remnant (FLR) hypertrophy by right or left PVE with EVOH as the only embolic agent between 2014 and 2018 at two academic centers. Cross-sectional imaging liver volumetry data obtained before and 3-6 weeks after PVE were used to assess the FLR volume (FLRV) increase, degree of FLR hypertrophy and the FLR kinetic growth rate (KGR). Results Twenty-six patients (17 males; mean age, 58.7±11 years; range, 32-79 years) were included. The technical and clinical success rate was 100%. PVE produced adequate FLR hypertrophy in all patients. Embolization occurred in all targeted portal branches and in no non-target vessels. The %FLRV increased by 52.9%±32.5% and the degree of FLR hypertrophy was 16.7%±6.8%. The KGR was 4.4%±2.0% per week. Four patients experience minor complications after PVE which resolved with symptomatic treatment. The resection rate was 84.5%. One patient died during surgery for reasons unrelated to PVE. Conclusions Preoperative PVE with EVOH copolymer is feasible, safe, and effective in inducing FLR hypertrophy.
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Affiliation(s)
- Sébastien Gautier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Charles Mastier
- Department of Interventional Radiology and Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Philippe d'Athis
- Department of Epidemiology and Biostatistics, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Frank Pilleul
- Department of Interventional Radiology and Oncology, Léon Bérard Cancer Center, Lyon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Patrick Rat
- Department of Digestive and Oncologic Surgery, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Facy
- Department of Digestive and Oncologic Surgery, François-Mitterrand University Hospital, Dijon, France
| | - Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
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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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9
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Jamieson RW, McBride OMB, Masson NM. Catheter entrapment in the aortic sac during Onyx embolization for type II endoleak. ANZ J Surg 2020; 91:E523-E525. [PMID: 33320423 DOI: 10.1111/ans.16492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 11/06/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Russell W Jamieson
- Edinburgh Vascular Surgical Service, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Olivia M B McBride
- Edinburgh Vascular Surgical Service, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Neil M Masson
- Department of Interventional Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
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10
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Scallan O, Kribs S, Power AH, DeRose G, Duncan A, Dubois L. Onyx versus coil embolization for the treatment of type II endoleaks. J Vasc Surg 2020; 73:1966-1972. [PMID: 33249208 DOI: 10.1016/j.jvs.2020.10.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 10/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Little evidence is available supporting the optimal treatment of type II endoleaks associated with aortic sac growth. Previous studies have lacked comparisons between treatment methods and long-term follow-up. The purpose of the present study was to review our center's experience with the treatment of type II endoleaks comparing Onyx (a liquid embolization agent consisting of ethylene vinyl alcohol; Medtronic, Minneapolis, Minn) embolization and coil embolization. METHODS A retrospective review of prospectively collected data from a vascular surgery database was performed to identify all patients who had undergone embolization of a type II endoleak for aortic sac growth after endovascular aneurysm repair from 2005 to 2018. The Onyx and coil embolization groups were compared using univariate statistics. RESULTS A total of 58 patients had undergone 77 embolization procedures for type II endoleaks with either Onyx (27 patients; 37 procedures) or coils (31 patients; 40 procedures). The average aneurysm size at embolization was larger in the Onyx group (77.9 ± 15.1 mm) compared with coil embolization (73.4 ± 11.9 mm). The mean follow-up was 57 months for the Onyx group and 74 months for the coil embolization group. Of the 27 patients who had undergone Onyx embolization, 2 (7.4%) had required graft explantation compared with 5 of the 31 patients (16.1%) who had undergone coil embolization (P = .33). The results of the per-patient analysis showed that the coil embolization group had a significantly greater rate of the need for further reintervention compared with the Onyx group (55% vs 19%; P < .01). Clinical success was observed in 13 patients (48%) in the Onyx embolization group compared with 10 patients (32%) in the coil embolization group (P = .04). Two patients in each group had presented with secondary rupture of the aneurysm sac after attempted embolization. CONCLUSIONS Type II endoleaks associated with sac growth treated with Onyx were less likely to require further reinterventions than were those treated with coil embolization. A trend was found toward a greater need for endovascular aneurysm repair explant after coil embolization. With a high rate of further reintervention and potential for sac rupture, diligent follow-up is required after attempted type II embolization, regardless of the technique used.
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Affiliation(s)
- Oonagh Scallan
- Department of Vascular Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stewart Kribs
- Department of Interventional Radiology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Adam H Power
- Department of Vascular Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Guy DeRose
- Department of Vascular Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Audra Duncan
- Department of Vascular Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Luc Dubois
- Department of Vascular Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
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11
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Menges AL, Trenner M, Radu O, Beddoe D, Kallmayer M, Zimmermann A, Eckstein HH. Lack of durability after transarterial ethylene-vinyl alcohol copolymer-embolization of type II endoleak following endovascular abdominal aortic aneurysm repair. VASA 2020; 49:483-491. [PMID: 33103625 DOI: 10.1024/0301-1526/a000905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Type II endoleak (T2EL) after endovascular aortic repair is associated with AAA sac enlargements in up to 25%, reduction of attachment zones and rarely with aortic rupture. Indications for therapy and efficacy of interventions of T2EL are not clearly established. Transarterial embolization with application of ethylene-vinyl alcohol copolymer has been described with varying outcomes. Aim of this study is to evaluate durability of OnyxTM embolization (OE) in T2EL in a consecutive series at a single tertiary vascular center. Patients and methods: Demographic data, technical success, pre- and postoperative aneurysm growth, morbidity, mortality and reintervention rates during hospital stay as well as in follow up were recorded in patients treated with OE for T2EL between 01/2015 and 12/2017. The primary endpoint was defined as persistence or reoccurrence of T2EL (durability of OE). Results: In total 15 patients (78 ± 6 years, 13 men) were treated with OE because of sac enlargement (average growth of 12 ± 8%, n = 12), persistent bleeding after AAA rupture (n = 2) or persistent T2EL with stable but large aneurysm diameter (n = 1). Mean length of stay was 8 ± 11 days. Technical success was 93.3% (n = 14). Inhospital-morbidity was 26.7%, in-hospital- and 1-year-mortality rate were 6.6% (n = 1) and 20.0% (n = 3). T2EL persisted in 20.0% (n = 3) despite of OE. Re-EL-II occurred after 40 (30-114) days in 33.3% (n = 5). Reintervention rate was 13.3% (n = 2, at day 48 and 319). Altogether clinical success with stable aneurysm diameter was achieved in 80.0% (n = 12), but durable elimination of EL was only achieved in 46.7% of patients (n = 7). Conclusions: OE is technically possible in more than 90% of patients but might be associated with severe complications. Durability of this treatment is low, since T2EL persist or reoccur in more than 50% of all patients. OE of T2EL should be reserved for few selected cases.
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Affiliation(s)
- Anna-Leonie Menges
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Matthias Trenner
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Oksana Radu
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daisy Beddoe
- Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Michael Kallmayer
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Alexander Zimmermann
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Vascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery and Munich Aortic Center (MAC), University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
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12
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Tomczak J, Gabriel M, Snoch-Ziółkiewicz M, Dzieciuchowicz Ł, Strauss E, Pawlaczyk K. Angio PLanewave UltraSensitive Imaging (Angio PL.U.S.) as an Innovative Doppler Ultrasound Technique with a Potential to follow up Endoleaks after Endovascular Aneurysm Repair (EVAR). ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1707-1714. [PMID: 32402670 DOI: 10.1016/j.ultrasmedbio.2020.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/16/2020] [Accepted: 03/21/2020] [Indexed: 06/11/2023]
Abstract
The aim of the study was to evaluate the effectiveness of Angio PLanewave UltraSensitive imaging (Angio PL.U.S.) as an alternative to contrast-enhanced ultrasound (CEUS) and computed tomography angiography (CTA) for endoleak detection and classification in patients after endovascular aneurysm repair. A total of 28 patients underwent a post-endovascular aneurysm repair follow-up with color Doppler ultrasound, power Doppler ultrasound, CEUS, Angio PL.U.S and CTA examinations. CTA revealed 17 endoleaks in 14 patients (50%): 3 type Ia, 13 type II and 1 type III. There were no differences between Angio PL.U.S. and CEUS in terms of sensitivity, specificity or accuracy (93%, 100% and 97%). We did not observe any statistically significant differences between CTA, CEUS and Angio PL.U.S. in terms of the endoleak identification ability. Angio PL.U.S. may be considered as a potential tool to follow-up patients after endovascular aneurysm repair implantation, especially in patients who cannot be examined with CTA or CEUS.
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Affiliation(s)
- Jolanta Tomczak
- Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, Poznan, Poland.
| | - Marcin Gabriel
- Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Łukasz Dzieciuchowicz
- Department of Vascular Surgery and Vascular Diseases, University of Zielona Góra, Zielona Góra, Poland
| | - Ewa Strauss
- Department of Vascular and Endovascular Surgery, Angiology and Phlebology, Poznan University of Medical Sciences, Poznan, Poland; Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | - Katarzyna Pawlaczyk
- Department of Hypertensiology, Angiology and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland
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13
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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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14
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Cannavale A, Lucatelli P, Corona M, Nardis P, Basilico F, De Rubeis G, Santoni M, Catalano C, Bezzi M. Evolving concepts and management of endoleaks after endovascular aneurysm repair: where do we stand in 2019? Clin Radiol 2019; 75:169-178. [PMID: 31810539 DOI: 10.1016/j.crad.2019.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/31/2019] [Indexed: 11/27/2022]
Abstract
In recent years, there has been tremendous progress in endovascular aneurysm repair (EVAR) techniques and devices. This process has seen a change in incidence, risk factors, and treatment of endoleaks as well as in follow-up protocols after EVAR. In particular, recent literature has highlighted new concepts in the evaluation and prevention/treatment of type I and II endoleak after standard EVAR. There is also recent evidence regarding new imaging protocols for follow-up after EVAR, which include magnetic resonance imaging and contrast-enhanced ultrasound. This comprehensive review aims to outline the most recent concepts on imaging follow-up, pathophysiology/risk factors, and management of endoleaks.
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Affiliation(s)
- A Cannavale
- Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
| | - P Lucatelli
- Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - M Corona
- Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - P Nardis
- Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - F Basilico
- Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - G De Rubeis
- Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - M Santoni
- Department of Radiological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - C Catalano
- Department of Radiological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - M Bezzi
- Vascular and Interventional Unit, Department of Radiological Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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15
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Kuziez MS, Picus D, Sanchez LA, Zayed MA. Trans-luminal repair of a ruptured AAA with Type Ia and Type II endoleaks. J Surg Case Rep 2018; 2018:rjy254. [PMID: 30310643 PMCID: PMC6174628 DOI: 10.1093/jscr/rjy254] [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: 08/05/2018] [Accepted: 09/17/2018] [Indexed: 11/13/2022] Open
Abstract
Ruptured abdominal aortic aneurysm (rAAA) with an associated Type II endoleak is rare. Emergent surgical repair is often necessary and may be associated with high morbidity and mortality. We report an alternative unique trans-luminal repair strategy in an 84-year-old male who presented with a rAAA with prior EVAR, and Type Ia and Type II endoleaks. The operative strategy consisted of proximal endograft extension into the para-renal aorta, followed by staged sac embolization using glue. Postoperatively, the patient recovered well from the repair, and follow-up imaging demonstrated a stable repair.
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Affiliation(s)
- Mohamed S Kuziez
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Daniel Picus
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Interventional Radiology Section, Washington University School of Medicine, Mallinckrodt Institute of Radiology, St. Louis, MO, USA
| | - Luis A Sanchez
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Mohamed A Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Department of Surgery, Veterans Affairs St. Louis Health Care System, St. Louis, MO, USA
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16
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Breguet R, Boudabbous S, Pupulim LF, Becker CD, Rubbia-Brandt L, Toso C, Ronot M, Terraz S. Ethylene vinyl alcohol copolymer for occlusion of specific portal branches during preoperative portal vein embolisation with n-butyl-cyanoacrylate. Eur Radiol 2018; 28:4810-4817. [PMID: 29789913 DOI: 10.1007/s00330-018-5476-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/04/2018] [Accepted: 04/11/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate the safety and efficacy of ethylene vinyl alcohol copolymer (EVOH) injection for selective occlusion of portal branches considered at risk for non-target embolisation during preoperative portal vein embolisation (PVE). METHODS Twenty-nine patients (mean age, 57 ± 17 years) submitted to PVE with n-butyl-cyanoacrylate (NBCA) and additional EVOH for selected portal branches were retrospectively analysed. Indications for the use of EVOH and the selected portal branches were evaluated. Degree of hypertrophy of the future liver remnant (FLR) and kinetic growth were assessed by CT volumetry performed before and 3-6 weeks after PVE. Clinical outcome and histopathological analysis of portal veins occluded with EVOH were reviewed. RESULTS EVOH was indicated intraoperatively for embolisation of selected portal branches that the operator reported at risk to provoke non-target embolisation with NBCA. Indications for the use of EVOH were embolisation of segment IV (n = 21), embolisation of segmental portal branches with early bifurcation (n = 7) and PVE in a 1-year-old girl with cystic hamartomas. All targeted portal branches were successfully embolised. There were no cases with non-target embolisation by EVOH. The degree of hypertrophy of the FLR was 14.3 ± 8.1% and the kinetic growth rate was 2.7 ± 1.8% per week. CONCLUSION EVOH is safe and effective for embolisation of selected portal vein branches considered at risk for non-target embolisation. KEY POINTS • EVOH is another effective liquid embolic agent for preoperative PVE. • EVOH is relatively simple to handle with a minimal risk of non-target embolisation. • During PVE, some portal branches considered complicated to occlude with NBCA may be efficiently embolised with EVOH.
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Affiliation(s)
- Romain Breguet
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland
| | - Sana Boudabbous
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Lawrence F Pupulim
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Christoph D Becker
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland
| | - Laura Rubbia-Brandt
- Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland.,Department of Clinical Pathology, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Toso
- Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland.,Department of Visceral Surgery, University Hospitals of Geneva, Geneva, Switzerland
| | - Maxime Ronot
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Department of Radiology, University Hospitals of Beaujon, Paris, France
| | - Sylvain Terraz
- Department of Radiology, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland. .,Hepato-Pancreato-Biliary Centre, University Hospitals of Geneva, Geneva, Switzerland.
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17
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Haskal ZJ. The Liquid Life. J Vasc Interv Radiol 2017; 28:840-841. [DOI: 10.1016/j.jvir.2017.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022] Open
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18
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Marcelin C, Le Bras Y, Petitpierre F, Midy D, Ducasse E, Grenier N, Cornelis F. Safety and efficacy of embolization using Onyx ® of persistent type II endoleaks after abdominal endovascular aneurysm repair. Diagn Interv Imaging 2017; 98:491-497. [PMID: 28196614 DOI: 10.1016/j.diii.2017.01.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/03/2017] [Accepted: 01/09/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To retrospectively evaluate the safety and efficacy of embolization of persistent type II endoleaks occurring after abdominal endovascular aneurysm repair (EVAR) using ethylene vinyl alcohol copolymer (Onyx®). MATERIAL AND METHODS Between 2008 and 2016, 28 consecutives patients (25 men, 3 women) with a mean age of 75.3years±9 (SD) (range: 59-90years) were treated for 29 persistent type II endoleaks with increasing aneurysm size>5mm occurring after EVAR. A total of 35 embolization procedures were performed using Onyx®, via a transarterial route (n=25) or direct puncture (n=10), with or without additional metallic coils. The endpoints were to evaluate the clinical efficacy, corresponding to the stabilization or decrease of aneurism size, and the technical efficacy, corresponding to the ability to complete the embolization. RESULTS No severe complications were observed during and after embolization. The primary and secondary clinical efficacies were 75% (21/28) and 96.4% (27/28), respectively. Overall primary technical efficacy rate was 58.6% (17/29), greater for transarterial technique (72.8%) than for direct puncture (14.3%) (P=0.01). Secondary technical efficacy was 72.4% (21/29), with no differences between transarterial (81.8%) and direct puncture (42.8%) (P=0.06). CONCLUSION Embolization with Onyx® of type II endoleaks after EVAR appears a safe and effective procedure.
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Affiliation(s)
- C Marcelin
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France.
| | - Y Le Bras
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - F Petitpierre
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - D Midy
- Department of vascular surgery, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - E Ducasse
- Department of vascular surgery, groupe hospitalier Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - N Grenier
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - F Cornelis
- Department of radiology, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France
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19
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Kuziez MS, Sanchez LA, Zayed MA. Abdominal Aortic Aneurysm Type II Endoleaks. JOURNAL OF CARDIOVASCULAR DISEASES & DIAGNOSIS 2016; 4. [PMID: 27857945 PMCID: PMC5110147 DOI: 10.4172/2329-9517.1000255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Type II endoleaks occur commonly following endovascular aneurysm repair (EVAR). Although they remain enigmatic, multiples studies have evaluated preoperative risk factors and strategies for prevention of type II endoleaks. Prophylactic treatment of type II endoleaks can include embolization of accessory arteries, as well as complete aneurysmal sac occlusion. Regular post-operative surveillance and screening for type II endoleaks with triple-phase CTA is the standard of care. Aneurysm size and growth rate are factors that predict whether a persistence type II endoleak is hemodynamically significant, and whether it requires treatment with percutaneous trans-lumbar or trans-arterial embolization techniques. Less commonly, type II endoleaks can be repaired using laparoscopic or open surgical ligation of feeder arterial branches. Emerging methods using endovascular aneurysm sac sealing technology may continue to alter the incidence and long-term management strategies of type II endoleaks. Here we review the latest strategies in the treatment of Type II endoleaks following EVAR.
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Affiliation(s)
- Mohamed S Kuziez
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Luis A Sanchez
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mohamed A Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA; Department of Surgery, Veterans Affairs St. Louis Health Care System, St. Louis, Missouri, USA
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