La radiologia medica

, Volume 123, Issue 8, pp 638–642 | Cite as

The role of ethylene–vinyl alcohol copolymer in association with other embolic agents for the percutaneous and endovascular treatment of type Ia endoleak

  • Anna Maria Ierardi
  • Marco Franchin
  • Federico Fontana
  • Gabriele Piffaretti
  • Matteo Crippa
  • Salvatore Alessio Angileri
  • Alberto Magenta Biasina
  • Filippo Piacentino
  • Matteo Tozzi
  • Antonio Pinto
  • Gianpaolo CarrafielloEmail author



To evaluate safety, technical and clinical success of embolization of type Ia endoleak (T1a EL) using ethylene–vinyl alcohol copolymer as embolic agent alone or in combination with other materials.

Materials and methods

Five patients presented T1a EL after endovascular repair of aortic aneurysms (EVAR) with radiological evidence of expanding sac size; in particular, three had contained rupture. In one patient, proximal cuff insertion was previously performed, in three patients proximal cuff was urgently inserted but T1a EL persisted; one patient, previously treated with Ovation Abdominal Stent Graft System, was directly proposed for endovascular treatment. In all cases, endovascular embolization was successfully performed and the transfemoral approach was always chosen; in one case it failed and translumbar approach by direct puncture of the sac was required. Used embolization agents were glue, ethylene–vinyl alcohol copolymer (Onyx) and coils in three cases, n-butyl cyanoacrylate and Onyx in one case, Onyx and coils in the last case.


Technical success rate was 100% as well as clinical success. No major or minor complication, including non-target embolization, was registered. Clinical success was 100% until today and the sac diameter remained stable in four patients and decreased in one.


Onyx may be considered a suitable embolic agent in the treatment of patients with type Ia endoleaks after EVAR, after failure of conventional treatments such as prolonged balloon inflation of the aortic neck or deployment of large bare stent.


Endovascular treatment Type Ia endoleak Embolization Ethylene–vinyl alcohol copolymer 


Compliance with ethical standards

Conflict of interest

All authors declare to have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.


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Copyright information

© Italian Society of Medical Radiology 2018

Authors and Affiliations

  • Anna Maria Ierardi
    • 1
  • Marco Franchin
    • 2
  • Federico Fontana
    • 3
  • Gabriele Piffaretti
    • 2
  • Matteo Crippa
    • 4
  • Salvatore Alessio Angileri
    • 1
  • Alberto Magenta Biasina
    • 1
  • Filippo Piacentino
    • 3
  • Matteo Tozzi
    • 2
  • Antonio Pinto
    • 5
  • Gianpaolo Carrafiello
    • 1
    Email author
  1. 1.Diagnostic and Interventional Radiology Department, San Paolo HospitalUniversity of MilanMilanItaly
  2. 2.Vascular Surgery DepartmentUniversity of InsubriaVareseItaly
  3. 3.Interventional Radiology, Department of RadiologyInsubria UniversityVareseItaly
  4. 4.Vascular Surgery Unit, Department of Surgery, San Paolo HospitalUniversity of MilanMilanItaly
  5. 5.Department of RadiologyCaldarelli HospitalNaplesItaly

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