Khaja Minhaj S, Park Auh Whan, Swee Warren, Evans Avery J, Fritz Angle J, Turba Ulku C, Sabri Saher S, Matsumoto Alan H
Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, 22908, USA,
Cardiovasc Intervent Radiol. 2014 Jun;37(3):613-22. doi: 10.1007/s00270-013-0706-z. Epub 2013 Aug 1.
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.
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.
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.
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.
我们研究的目的是报告我们非标签使用乙烯-乙烯醇共聚物（Onyx）治疗胸主动脉（TEVAR）和腹主动脉（EVAR）血管腔内修复术后II型内漏的经验。
对接受Onyx治疗的I型和/或II型内漏患者进行回顾性分析。收集有关技术、临床和影像学结果的数据。技术成功定义为首次影像学随访时内漏减少或消失。临床成功定义为在后续随访中动脉瘤囊大小无变化或减小。
18例患者（15例男性，3例女性）符合纳入标准，平均年龄79岁（69 - 92岁）（16例腹主动脉瘤，2例胸主动脉瘤）。16例患者为II型内漏，2例为伴有I型成分的复杂II型内漏。腔内修复与治疗的间隔时间平均为30个月。13例患者采用直接瘤囊治疗方法；3例患者采用经动脉治疗方法。7例患者需要使用弹簧圈、N-丁基氰基丙烯酸酯胶或Amplatzer血管封堵器。每次治疗使用Onyx的平均体积为5.6 mL（2.5 - 13 mL）。影像学随访时间为0.75 - 72.5个月（平均32.8个月）。18例患者中有16例（88.9%）获得了初始技术和临床成功。18例患者中有2例（11.1%）初始技术失败，其中1例尽管进行了二次治疗并尝试手术结扎仍失败。18例患者中有8例（44.4%）最终需要二次干预，其中5例（27.8%）是由于延迟的临床失败。并发症包括1例腰大肌血肿、1例短暂性L2神经麻痹和1例瘤囊内Onyx渗漏；所有这些均无临床后遗症。
无论是否联合弹簧圈/胶/Amplatzer封堵器栓塞，Onyx在治疗TEVAR和EVAR术后II型内漏方面是安全且有效的。然而，需要长期的临床和影像学随访以早期发现和处理原发性内漏复发、新的继发性内漏形成或动脉瘤囊增大。
