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

  • VASCULAR AND INTERVENTIONAL RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Aim

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.

Results

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.

Conclusions

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.

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References

  1. Walker TG, Kalva SP, Yeddula K, Wicky S, Kundu S, Drescher P, d’Othee BJ, Rose SC, Cardella JF (2010) Clinical practice guidelines for endovascular abdominal aortic aneurysm repair: written by the Standards of Practice Committee for the Society of Interventional Radiology and endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association. J Vasc Interv Radiol 21(11):1632–1655

    Article  PubMed  Google Scholar 

  2. Mehta M, Sternbach Y, Taggert JB, Kreienberg PB, Roddy SP, Paty PS, Ozsvath KJ, Darling RC (2010) Long-term outcomes of secondary procedures after endovascular aneurysm repair. J Vasc Surg 52:1442–1449

    Article  PubMed  Google Scholar 

  3. Baum R, Stavropoulos W, Fairman RM, Carpenter JP (2003) Endoleaks after endovascular repair of abdominal aortic aneurysms. J Vasc Interv Radiol 14:1111–1117

    Article  PubMed  Google Scholar 

  4. Georgakarakos E, Argyriou C, Schoretsanitis N, Ioannou CV, Kontopodis N, Morgan R, Tsetis D (2014) Geometrical factors influencing the hemodynamic behavior of the AAA stent grafts: essentials for the clinician. Cardiovasc Interv Radiol 37(6):1420–1429

    Article  Google Scholar 

  5. Venermo MA, Arko FR 3rd, Salenius JP, Saarinen JP, Zvaigzne A, Zarins CK (2011) EVAR may reduce the risk of aneurysm rupture despite persisting type Ia endoleaks. J Endovasc Ther 18:676–682

    Article  PubMed  Google Scholar 

  6. Khaja MS, Park AW, Swee W, Evans AJ, Angle JF, Turba UC, Sabri SS, Matsumoto AH (2014) Treatment of type II endoleak using Onyx with long-term imaging follow-up. Cardiovasc Interv Radiol 37(3):613–622

    Article  Google Scholar 

  7. Grisafi JL, Boiteau G, Detschelt E, Potts J, Kiproff P, Muluk SC (2010) Endoluminal treatment of type IA endoleak with Onyx. J Vasc Surg 52(5):1346–1349

    Article  PubMed  Google Scholar 

  8. Maldonado TS, Rosen RJ, Rockman CB, Adelman MA, Bajakian D, Jacobowitz GR, Riles TS, Lamparello PJ (2003) Initial successful management of type I endoleak after endovascular aortic aneurysm repair with n-butyl cyanoacrylate adhesive. J Vasc Surg 38(4):664–670

    Article  PubMed  CAS  Google Scholar 

  9. Chun JY, Morgan R (2013) Transcatheter embolisation of type 1 endoleaks after endovascular aortic aneurysm repair with Onyx: when no other treatment option is feasible. Eur J Vasc Endovasc Surg 45(2):141–144

    Article  PubMed  Google Scholar 

  10. Rand T, Uberoi R, Cil B, Munneke G, Tsetis D (2013) Quality improvement guidelines for imaging detection and treatment of endoleaks following endovascular aneurysm repair (EVAR). Cardiovasc Intervent Radiol 36:35–45

    Article  PubMed  CAS  Google Scholar 

  11. Cao P, De Rango P, Verzini F, Parlani G (2010) Endoleak after endovascular aortic repair: classification, diagnosis and management following endovascular thoracic and abdominal aortic repair. J Cardiovasc Surg 51:53–69

    CAS  Google Scholar 

  12. Choi SY, Won JY, do Lee Y, Choi D, Shim WH, Lee KH (2010) Percutaneous transabdominal approach for the treatment of endoleaks after endovascular repair of infrarenal abdominal aortic aneurysm. Korean J Radiol 11:107–114

    Article  PubMed  Google Scholar 

  13. Eberhardt KM, Sadeghi-Azandaryani M, Worlicek S, Koeppel T, Reiser MF, Treitl M (2014) Treatment of type I endoleaks using transcatheter embolization with onyx. J Endovasc Ther 21(1):162–171

    Article  PubMed  Google Scholar 

  14. Henrikson O, Roos H, Falkenberg M (2011) Ethylene vinyl alcohol copolymer (Onyx) to seal type 1 endoleak. A new technique. Vascular 19(2):77e81

    Article  Google Scholar 

  15. Guimaraes M, Wooster M (2011) Onyx (ethylene-vinyl alcohol copolymer) in peripheral applications. Semin Interv Radiol 28:350–356

    Article  Google Scholar 

  16. Ierardi AM, Micieli C, Angileri SA, Rivolta N, Piffaretti G, Tonolini M, Fontana F, Miele V, Brunese L, Carrafiello G (2017) Ethylene-vinyl alcohol copolymer as embolic agent for treatment of type II endoleak: our experience. Radiol Med 122(2):154–159

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Diagnostic and Interventional Radiology Department, San Paolo Hospital, University of Milan, Milan, Italy

    Anna Maria Ierardi, Salvatore Alessio Angileri, Alberto Magenta Biasina & Gianpaolo Carrafiello

  2. Vascular Surgery Department, University of Insubria, Viale Borri, 57, 21100, Varese, VA, Italy

    Marco Franchin, Gabriele Piffaretti & Matteo Tozzi

  3. Interventional Radiology, Department of Radiology, Insubria University, Viale Borri, 57, 21100, Varese, VA, Italy

    Federico Fontana & Filippo Piacentino

  4. Vascular Surgery Unit, Department of Surgery, San Paolo Hospital, University of Milan, Milan, Italy

    Matteo Crippa

  5. Department of Radiology, Caldarelli Hospital, Naples, Italy

    Antonio Pinto

Authors
  1. Anna Maria Ierardi
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  2. Marco Franchin
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  3. Federico Fontana
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  4. Gabriele Piffaretti
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  5. Matteo Crippa
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  6. Salvatore Alessio Angileri
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  7. Alberto Magenta Biasina
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  8. Filippo Piacentino
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  9. Matteo Tozzi
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  10. Antonio Pinto
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  11. Gianpaolo Carrafiello
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Corresponding author

Correspondence to Gianpaolo Carrafiello.

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All authors declare to have no conflict of interest.

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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.

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

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Ierardi, A.M., Franchin, M., Fontana, F. et al. 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 123, 638–642 (2018). https://doi.org/10.1007/s11547-018-0885-4

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  • DOI: https://doi.org/10.1007/s11547-018-0885-4

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