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

  • Per KjellinEmail author
  • Håkan Pärsson
  • Hans I. V. Lindgren
Clinical Investigation Arterial Interventions
Part of the following topical collections:
  1. Arterial Interventions



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.


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.


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.


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.


Endovascular repair (EVAR) Abdominal aortic aneurysms (AAA) Onyx embolization Iliac arteries 



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


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.

Compliance with Ethical Standards

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.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  • Per Kjellin
    • 1
    • 3
    Email author
  • Håkan Pärsson
    • 1
    • 2
  • Hans I. V. Lindgren
    • 1
    • 3
  1. 1.Department of SurgeryHelsingborg HospitalHelsingborgSweden
  2. 2.Department of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden
  3. 3.Department of Clinical Sciences, Faculty of MedicineLund UniversityLundSweden

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