La radiologia medica

, Volume 124, Issue 2, pp 154–162 | Cite as

Transarterial embolization of peripheral high-flow arteriovenous malformation with ethylene vinyl alcohol copolymer (Onyx®): single-center 10-year experience

  • Francesco GiurazzaEmail author
  • Fabio Corvino
  • Gianluca Cangiano
  • Errico Cavaglià
  • Francesco Amodio
  • Mattia Silvestre
  • Giuseppe De Magistris
  • Raffaella Niola



High-flow arteriovenous malformations (AVMs) are complex vascular lesions for which transcatheter embolization is considered as first-choice treatment nowadays. Multiple embolizing agents have been described, and among them, Onyx® seems to be promising; this is a liquid embolic agent, originally applied in neurointerventional radiology and recently adopted also in peripheral embolizations. The aim of this study is to report on a 10-year experience of transarterial embolization of peripheral high-flow AVM with Onyx® in terms of technical and clinical outcomes.

Materials and methods

Retrospective analysis was conducted on patients affected by high-flow AVM and treated electively by transarterial embolization with Onyx®. Data collection included: preinterventional clinical radiological evaluations, procedural data and post-procedural clinical radiological assessment. Technical and clinical success was evaluated; follow-up was conducted 30 days after the last treatment session and yearly in case of success.


Sixteen patients have been included, totally 38 embolizing procedures. Additional embolizing agents were required in 5 patients. Technical success was obtained in 11 patients; at 30-day follow-up, 15 patients showed improvements in symptoms, even those with incomplete embolization; however, after almost 1 year from treatment accomplishment, 7 patients showed relapse of symptoms and presented radiological signs of AVM recurrence. No clinically relevant complications occurred.


In this series, in accordance with previous but limited published data, Onyx® appeared safe and technically effective to embolize high-flow peripheral AVM with transarterial approach. Clinical radiological follow-up is mandatory because new feeder recruitment has to be expected; patients should be informed of the concrete possibility of multiple treatment sessions.


Arteriovenous malformation Peripheral Embolization Onyx® 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants

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

Informed consent

Informed consent was obtained from all individual patients included in the study.


  1. 1.
    Saeed Kilani M, Lepennec V, Petit P et al (2017) Embolization of peripheral high-flow arteriovenous malformations with Onyx. Diagn Interv Imaging 98(3):217–226. CrossRefGoogle Scholar
  2. 2.
    Giurazza F, Corvino F, Cangiano G et al (2018) Sclerotherapy of peripheral low-flow vascular malformations: technical aspects and mid-term clinical outcome. Radiol Med. Scholar
  3. 3.
    Cho S, Do Y, Shin S et al (2006) Arteriovenous malformations of the body extremities: analysis of therapeutic outcomes and approaches according to a modified angiographic classification. J Endovasc Ther 13:527–538CrossRefGoogle Scholar
  4. 4.
    Park K, Do Y, Kim Y et al (2012) Predictive factors for response of peripheral arteriovenous malformations to embolization therapy: analysis of clinical data and imaging findings. J Vasc Intervent Radiol 23:1478–1486CrossRefGoogle Scholar
  5. 5.
    Nassiri N, Cirillo-Penn NC, Crystal DT (2017) Direct stick embolization of extremity arteriovenous malformations with ethylene vinyl alcohol copolymer. J Vasc Surg 65(4):1223–1228. CrossRefGoogle Scholar
  6. 6.
    Yakes WF (2015) Yakes’ AVM classification system. J Vasc Interv Radiol 26:S224CrossRefGoogle Scholar
  7. 7.
    Hyodoh H, Hori M, Hm Akiba et al (2005) Peripheral vascular malformations: imaging, treatment approaches and therapeutic issues. Radiographics 25(Suppl. 1):S159–S171CrossRefGoogle Scholar
  8. 8.
    Bowman J, Johnson J, McKusick M et al (2013) Outcomes of sclerotherapy and embolization for arteriovenous and venous malformations. Semin Vasc Surg 26:48–54CrossRefGoogle Scholar
  9. 9.
    De Beule T, Vranckx J, Verhamme P et al (2016) Transarterial embolization of peripheral arteriovenous malformations with ethylenevinyl alcohol copolymer—feasibility, technical outcomes, and clinical outcomes. Vasa 45(6):497–504CrossRefGoogle Scholar
  10. 10.
    Saeed Kilani M, Izaaryene J, Cohen F et al (2015) Ethylene vinyl alcohol copolymer (Onyx®) in peripheral interventional radiology: Indications, advantages and limitations. Diagn Interventional Imaging 96:319–326CrossRefGoogle Scholar
  11. 11.
    Ierardi AM, Franchin M, Fontana F, et al (2018) The role of ethylene-vinyl alcohol copolymer in association with other embolic agents for the percutaneous and endovascular treatment of type Ia endoleak. Radiol Med. Scholar
  12. 12.
    Ierardi AM, Micieli C, Angileri SA et al (2017) Ethylene-vinyl alcohol copolymer as embolic agent for treatment of type II endoleak: our experience. Radiol Med 22(2):154–159. CrossRefGoogle Scholar
  13. 13.
    Ierardi AM, Xhepa G, Duka E et al (2015) Ethylene-vinyl alcohol polymer trans-arterial embolization in emergency peripheral active bleeding: initial experience. Int Angiol 4(6 Suppl 1):28–35Google Scholar
  14. 14.
    Filippiadis DK, Binkert C, Pellerin O, Hoffmann RT, Krajina A, Pereira PL (2017) Cirse quality assurance document and standards for classification of complications: the cirse classification system. Cardiovasc Intervent Radiol 40:1141–1146CrossRefGoogle Scholar
  15. 15.
    Chevallier O, Gehin S, Foahom-Kamwa A et al (2016) Ethylene-vinyl alcohol copolymer (Onyx®) transarterial embolization for post-traumatic high-flow priapism. Quant Imaging Med Surg 6(3):323–327CrossRefGoogle Scholar
  16. 16.
    Cassinotto C, Lapuyade B (2015) Pancreatic arteriovenous malformation embolization with Onyx. JVIR 3:442–444. CrossRefGoogle Scholar
  17. 17.
    Eberhardt KM, Sadeghi-Azandaryani M, Worlicek S et al (2014) Treatment of type I endoleaks using transcatheter embolization with onyx. J Endovasc Ther. 21(1):162–171. CrossRefGoogle Scholar
  18. 18.
    Numan F, Omeroglu A, Kara B, Cantaşdemir M, Adaletli I, Kantarci F (2004) Embolization of peripheral vascular malformations with ethylene vinyl alcohol copolymer (Onyx). J Vasc Interv Radiol 15(9):939–946CrossRefGoogle Scholar
  19. 19.
    Wohlgemuth WA, Müller-Wille R, Teusch VI et al (2015) The retrograde transvenous push-through method: a novel treatment of peripheral arteriovenous malformations with dominant venous outflow. Cardiovasc Intervent Radiol. 38(3):623–631. CrossRefGoogle Scholar
  20. 20.
    Cantasdemir M, Gulsen F, Solak S, Gulsen GY, Kantarci F, Numan F (2012) The use of Onyx for embolization of peripheral vascular malformations in pediatric patients. Pediatr Surg Int 28(5):477–487. CrossRefGoogle Scholar
  21. 21.
    Lamin S, Chew HS, Chavda S et al (2017) Embolization of intracranial dural arteriovenous fistulas using PHIL liquid embolic agent in 26 patients: a multicenter study. AJNR Am J Neuroradiol 38(1):127–131. CrossRefGoogle Scholar
  22. 22.
    Newman CB, Park MS, Kerber CW, Levy ML, Barr JD, Pakbaz RS (2012) Over-the-catheter retrieval of a retained microcatheter following Onyxembolization: a technical report. J Neurointerv Surg. 4(4):e13. CrossRefGoogle Scholar
  23. 23.
    Vu PD, Grigorian AA (2015) Microcatheter entrapment retrieval from Onyx embolization in brain arteriovenous malformations: A technical note. Interv Neuroradiol. 21(5):620–623. CrossRefGoogle Scholar
  24. 24.
    Qureshi AI, Mian N, Siddiqi H (2015) Occurrence and management strategies for catheter entrapment with onyx liquid embolization. J Vasc Interv Neurol 8(3):37–41Google Scholar
  25. 25.
    Arat A, Cil BE, Vargel I et al (2007) Embolization of high-flow craniofacial vascular malformations with Onyx. Am J Neuroradiol 28:1409–1414CrossRefGoogle Scholar
  26. 26.
    Flores BC, See AP, Weiner GM, Jankowitz BT, Ducruet AF, Albuquerque FC (2018) Use of the Apollo detachable-tip microcatheter for endovascular embolization of arteriovenous malformations and arteriovenous fistulas. J Neurosurg 23:1–9. Google Scholar
  27. 27.
    Miller TR, Giacon L, Kole MJ, Chen R, Jindal G, Gandhi D (2018) Onyx embolization with the Apollo detachable tip microcatheter: a single-center experience. Interv Neuroradiol.

Copyright information

© Italian Society of Medical Radiology 2018

Authors and Affiliations

  1. 1.Interventional Radiology DepartmentAORN Cardarelli di NapoliNaplesItaly

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