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CardioVascular and Interventional Radiology

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01-06-2014 | Clinical Investigation

Treatment of Type II Endoleak Using Onyx With Long-Term Imaging Follow-Up

Authors: Minhaj S. Khaja, Auh Whan Park, Warren Swee, Avery J. Evans, J. Fritz Angle, Ulku C. Turba, Saher S. Sabri, Alan H. Matsumoto

Published in: CardioVascular and Interventional Radiology | Issue 3/2014

Abstract

Purpose

The purpose of our study is to report our experience with the use of an ethylene vinyl alcohol copolymer (Onyx) in an off-label fashion for the treatment of type II endoleak after endovascular repair of the thoracic (TEVAR) and abdominal (EVAR) aorta.

Methods

A retrospective review of patients with type I and/or II endoleak treated with Onyx was performed. Data regarding the technical, clinical, and imaging outcomes were collected. Technical success was defined as decreased or eliminated endoleak on the first imaging follow-up. Clinical success was defined as unchanged or decreased aneurysm sac size on subsequent follow-up.

Results

Eighteen patients (15 male, 3 female) with a mean age of 79 years (range 69–92) met inclusion criteria (16 abdominal aortic aneurysm, 2 thoracic aortic aneurysm). Sixteen patients had type II endoleak, and 2 had complex type II endoleak with a type I component. The interval between endograft placement and treatment was a mean of 30 months. Direct sac treatment approach was used in 13 patients; transarterial approach was used in 3 patients. Seven patients required the use of coils, N-butyl cyanoacrylate glue, or Amplatzer vascular plugs. The average volume of Onyx used per treatment was 5.6 mL (range 2.5–13). Duration of imaging follow-up was 0.75–72.5 months (mean 32.8). Sixteen of 18 (88.9 %) patients had initial technical and clinical success. Two of 18 patients (11.1 %) were initial technical failures, and 1 remained a failure despite a second treatment and attempted surgical ligation. Eight of 18 (44.4 %) of patients eventually required a second intervention, 5 (27.8 %) of them due to delayed clinical failure. Complications included 1 psoas hematoma, 1 transient L2 nerve paresis, and 1 intraperitoneal Onyx leak; all of these were without clinical sequelae.

Conclusion

Onyx with or without coil/glue/Amplatzer plug embolization is safe and useful in the treatment of type II endoleak after TEVAR and EVAR. However, long-term clinical and imaging follow-up is needed for early detection and management of recurrence of the primary endoleak or the development of new, secondary endoleaks or enlargement of the aneurysm sac.

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Title: Treatment of Type II Endoleak Using Onyx With Long-Term Imaging Follow-Up
Authors: Minhaj S. Khaja
Auh Whan Park
Warren Swee
Avery J. Evans
J. Fritz Angle
Ulku C. Turba
Saher S. Sabri
Alan H. Matsumoto
Publication date: 01-06-2014
Publisher: Springer US
Published in: CardioVascular and Interventional Radiology / Issue 3/2014
Print ISSN: 0174-1551
Electronic ISSN: 1432-086X
DOI: https://doi.org/10.1007/s00270-013-0706-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Treatment of Type II Endoleak Using Onyx With Long-Term Imaging Follow-Up

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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