Transarterial embolization of peripheral high-flow arteriovenous malformation with ethylene vinyl alcohol copolymer (Onyx®): single-center 10-year experience
- 36 Downloads
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.
KeywordsArteriovenous 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 was obtained from all individual patients included in the study.
- 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. https://doi.org/10.1007/s11547-018-0869-4Google Scholar
- 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. https://doi.org/10.1007/s11547-018-0885-4Google Scholar
- 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
- 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. https://doi.org/10.1007/s00270-015-1063-x CrossRefGoogle Scholar
- 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
- 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. https://doi.org/10.1177/1591019918758494