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Treatment of Type II Endoleak Using Onyx With Long-Term Imaging Follow-Up

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Abstract

Purpose

The purpose of our study is to report our experience with the use of an ethylene vinyl alcohol copolymer (Onyx) in an off-label fashion for the treatment of type II endoleak after endovascular repair of the thoracic (TEVAR) and abdominal (EVAR) aorta.

Methods

A retrospective review of patients with type I and/or II endoleak treated with Onyx was performed. Data regarding the technical, clinical, and imaging outcomes were collected. Technical success was defined as decreased or eliminated endoleak on the first imaging follow-up. Clinical success was defined as unchanged or decreased aneurysm sac size on subsequent follow-up.

Results

Eighteen patients (15 male, 3 female) with a mean age of 79 years (range 69–92) met inclusion criteria (16 abdominal aortic aneurysm, 2 thoracic aortic aneurysm). Sixteen patients had type II endoleak, and 2 had complex type II endoleak with a type I component. The interval between endograft placement and treatment was a mean of 30 months. Direct sac treatment approach was used in 13 patients; transarterial approach was used in 3 patients. Seven patients required the use of coils, N-butyl cyanoacrylate glue, or Amplatzer vascular plugs. The average volume of Onyx used per treatment was 5.6 mL (range 2.5–13). Duration of imaging follow-up was 0.75–72.5 months (mean 32.8). Sixteen of 18 (88.9 %) patients had initial technical and clinical success. Two of 18 patients (11.1 %) were initial technical failures, and 1 remained a failure despite a second treatment and attempted surgical ligation. Eight of 18 (44.4 %) of patients eventually required a second intervention, 5 (27.8 %) of them due to delayed clinical failure. Complications included 1 psoas hematoma, 1 transient L2 nerve paresis, and 1 intraperitoneal Onyx leak; all of these were without clinical sequelae.

Conclusion

Onyx with or without coil/glue/Amplatzer plug embolization is safe and useful in the treatment of type II endoleak after TEVAR and EVAR. However, long-term clinical and imaging follow-up is needed for early detection and management of recurrence of the primary endoleak or the development of new, secondary endoleaks or enlargement of the aneurysm sac.

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Conflict of interest

Avery J. Evans is a consultant and proctor for eV3 Neurovascular. J. Fritz Angle is a consultant for Terumo Medical and received a grant from Siemens Medical. Alan H. Matsumoto sits on the Data Safety Monitoring Board for the Trivascular, Bolton Medical, Boston Scientific, and Medicines companies; has received institutional grants from W. L. Gore, Medtronic, Cook Medical, and InSightec; holds personal stock or stock options of Crux Medical; and has received other travel/accommodations/meeting expenses from Siemens Medical. None of these are relevant to this manuscript.

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Authors and Affiliations

  1. Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, 22908, USA

    Minhaj S. Khaja, Auh Whan Park, Avery J. Evans, J. Fritz Angle, Ulku C. Turba, Saher S. Sabri & Alan H. Matsumoto

  2. South Florida Vascular Associates, Coconut Creek, FL, 33073, USA

    Warren Swee

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  1. Minhaj S. Khaja
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Correspondence to Minhaj S. Khaja.

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Khaja, M.S., Park, A.W., Swee, W. et al. Treatment of Type II Endoleak Using Onyx With Long-Term Imaging Follow-Up. Cardiovasc Intervent Radiol 37, 613–622 (2014). https://doi.org/10.1007/s00270-013-0706-z

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  • DOI: https://doi.org/10.1007/s00270-013-0706-z

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