Skip to main content

Advertisement

SpringerLink
Log in

Onyx Embolization for Occlusion of the Proximal Internal Iliac Artery During EVAR in Patients with Unsuitable Landing Zones in the Common Iliac Artery

  • Clinical Investigation
  • Arterial Interventions
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Background

Twenty percent of the patients with AAA have an aneurysm involving the common iliac arteries. Large common iliac diameter can be treated with an iliac branched device or extension of the stent graft to the external iliac artery with occlusion of the ipsilateral internal iliac artery (IIA) to prevent type 2 endoleaks. This study describes and evaluates a embolization technique using Onyx in conjunction with EVAR in aneurysms with poor landing zones in the common iliac arteries.

Methods

Patients with Onyx IIA embolization during EVAR, identified from the hospital operating code database, constitute the study population. Onyx embolization was performed by injection at the IIA origin. Peri- and postoperative complications were collected from the medical records. Thin-sliced CT scan was performed 1 month and 1 year after the procedure.

Results

Thirty-six patients with complex iliac anatomy and insufficient landing zones (without sealing possibility for standard stent grafts) were identified out of 243 consecutive EVAR treatments during a 13-year period. In seventeen patients (7%), the IIA was embolized with Onyx. Technical success was obtained in all 17 patients, without adverse event or procedural complication. No complication related to the embolization procedure was noted during follow-up.

Conclusions

During EVAR treatment of patients with aneurysm involving the common iliac artery, Onyx embolization of IIA is a feasible option without need of selective catheterization of the IIA orifice, potentially preserving important branches of the IIA and simplifying emergency procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Patel R, Sweeting MJ, Powell JT, Greenhalgh RM, EVAR Trial Investigators. Endovascular versus open repair of abdominal aortic aneurysm in 15-years’ follow-up of the UK endovascular aneurysm repair trial 1 (EVAR trial 1): a randomised controlled trial. Lancet. 2016;388(10058):2366–74.

    Article  Google Scholar 

  2. Powell JT, Sweeting MJ, Ulug P, Blankensteijn JD, Lederle FA, Becquemin JP et al. EVAR-1, DREAM, OVER and ACE Trialists. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years. Br J Surg. 2017;104:166–78.

    Article  Google Scholar 

  3. Armon MP, Wenham PW, Whitaker SC, Gregson RH, Hopkinson BR. Common iliac artery aneurysms in patients with abdominal aortic aneurysms. Eur J Vasc Endovasc Surg. 1998;15(3):255–7.

    Article  CAS  PubMed  Google Scholar 

  4. Baum RA, Stavropoulos SW, Fairman RM, Carpenter JP. Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol. 2003;14(9 Pt 1):1111–7.

    Article  PubMed  Google Scholar 

  5. McDonnel CO, Semmens JB, Allen YB, Jansen SJ, Brooks DM, Lawrence-Brown MM. Large iliac arteries: a high-risk group for endovascular aortic aneurysm repair. J Endovasc Ther. 2007;14(5):625–9.

    Article  Google Scholar 

  6. Torsello G, Schönefeld E, Osada N, Austermann M, Pennekamp C, Donas KP. Endovascular treatment of common iliac artery aneurysms using the bell-bottom technique: long-term results. J Endovasc Ther. 2010;17(4):504–9.

    Article  PubMed  Google Scholar 

  7. Verzini F, Parlani G, Romano L, De Rango P, Panuccio G, Cao P. Endovascular treatment of iliac aneurysm: concurrent comparison of side branch endograft versus hypogastric exclusion. J Vasc Surg. 2009;49(5):1154–61.

    Article  PubMed  Google Scholar 

  8. Vieth FJ, Baum RA, Ohki T, Amor M, Adiseshiah M, Blankensteijn JD, et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference. J Vasc Surg. 2002;35(5):1029–35.

    Article  Google Scholar 

  9. Libicher M, Pavlidis D, Bangard C, Gawenda M. Occlusion of the internal iliac artery prior EVAR: comparison of coils and plugs. Vasc Endovasc Surg. 2012;46(1):34–9.

    Article  Google Scholar 

  10. Vanninen RL, Manninen I. Onyx, a new liquid embolic material for peripheral interventions: preliminary experience in aneurysm, pseudoaneurysm and pulmonary arteriovenous malformation embolization. Cardiovasc Interv Radiol. 2007;30(2):196–200.

    Article  Google Scholar 

  11. Cekirge HS, Saatci I, Ozturk MH, Cil B, Arat A, Mawad M, et al. Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single center experience. Neuroradiology. 2006;48(2):113–26.

    Article  PubMed  Google Scholar 

  12. Bosiers MJ, Deloose K, Peeters P, Torsello G, Zeller T, Scheinert D, et al. Midterm results of the transarterial use of Onyx in the treatment of persisting type II endoleaks after EVAR. J Cardiovasc Surg (Torino). 2013;54(4):469–75.

    CAS  Google Scholar 

  13. Harrison GJ, Thavarajan D, Brennan JA, Vallabhaneni SR, McWilliams RG, Fisher RK. Fascial closure following percutaneous endovascular aneurysm repair. Eur J Vasc Endovasc Surg. 2011;41(3):346–9.

    Article  CAS  PubMed  Google Scholar 

  14. Gray D, Shahverdyan R, Reifferscheid V, Gawenda M, Brunkwall JS. EVAR with flared iliac limbs has a high risk of late type 1b endoleak. Eur J Vasc Endovasc Surg. 2017;54(2):170–6.

    Article  CAS  PubMed  Google Scholar 

  15. Mansukhani NA, Havelka GE, Helenowski IB, Rodriguez HE, Hoel AW, Eskandari MK. Hybrid EVAR: preservation of pelvic perfusion with external to internal iliac artery bypass. Ann Vasc Surg. 2017;42:162–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bosanquet DC, Wilcox C, Whitehurst L, Cox A, Williams IM, Twine CP. Systematic review and meta-analysis of the effect of internal iliac artery exclusion for patients undergoing EVAR. Eur J Vasc Endovasc Surg Off J Eur Soc Vasc Surg. 2017;53(4):534–48.

    Article  CAS  Google Scholar 

  17. Saengprakai W, van Herwaarden JA, Georgiadis GS, Slisatkorn W, Moll FL. Clinical outcomes of hypogastric artery occlusion for endovascular aortic aneurysm repair. Minim Invasive Ther Allied Technol MITAT Off J Soc Minim Invasive Ther. 2017;26(6):362–71.

    Article  Google Scholar 

Download references

Acknowledgements

This study has been possible through the generous support from the Stig and Ragna Gorthon’s foundation for medical research.

Funding

This study has been possible through the generous support from the Stig and Ragna Gorthon’s foundation for medical research, not involved in the design of the study and collection, analysis, and interpretation of data and in writing.

Author information

Authors and Affiliations

  1. Department of Surgery, Helsingborg Hospital, 251 87, Helsingborg, Sweden

    Per Kjellin, Håkan Pärsson & Hans I. V. Lindgren

  2. Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden

    Håkan Pärsson

  3. Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden

    Per Kjellin & Hans I. V. Lindgren

Authors
  1. Per Kjellin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Håkan Pärsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hans I. V. Lindgren
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Per Kjellin.

Ethics declarations

Conflict of interest

P. Kjellin and H. Pärsson have nothing to disclose. Hans Lindgren has received compensation according to a proctoring and training agreement with ev3 Nordic AB and William Cook Europe ApS. These sponsors had no involvement in any part of the study. The study was conducted without sponsoring from any medical device company.

Consent for Publication

For this type of study consent for publication is not required.

Ethical Approval

The study was performed in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study was approved by the Swedish Ethical Review Authority 2019-00452.

Informed Consent

Informed consent was obtained from all patients.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kjellin, P., Pärsson, H. & Lindgren, H.I.V. Onyx Embolization for Occlusion of the Proximal Internal Iliac Artery During EVAR in Patients with Unsuitable Landing Zones in the Common Iliac Artery. Cardiovasc Intervent Radiol 42, 956–961 (2019). https://doi.org/10.1007/s00270-019-02188-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-019-02188-8

Keywords

Search

Navigation