title: Onyx pulmonary artery embolization after treatment of a low-flow dural arteriovenous fistula: case report.
abstract: BACKGROUND
  Endovascular management of dural arteriovenous fistulas (DAVFs) has become an accepted primary and often definitive therapy. We present the first documented case of Onyx pulmonary embolism after embolization of a low-flow DAVF.
  
  
  METHODS
  A 63-year-old man presented with subarachnoid hemorrhage secondary to a DAVF. Computed tomographic angiography, magnetic resonance imaging, and initial conventional angiogram were negative. A repeat angiogram demonstrated a DAVF, which was cured with Onyx embolization. A routine chest computed tomography after intervention revealed an asymptomatic Onyx embolization cast in a subsegmental pulmonary artery.
  
  
  CONCLUSIONS
  Endovascular treatment options include transarterial embolization with microcoils, polyvinyl alcohol particles, n-butyl-2cyanoacrylate, and Onyx (ev3 Neurovascular, Irvine, California). Complications associated with the use of Onyx are low but include embolizate pulmonary embolism. Patients often remain asymptomatic, but for symptomatic patients, conservative treatment options usually result in resolution of symptoms.
authors.affiliation: Department of Radiology, Division of Interventional Neuroradiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA. bryan.pukenas@uphs.upenn.edu
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Pukenas
authors.forename: Sudhakar R
authors.initials: SR
authors.lastname: Satti
authors.forename: Robert
authors.initials: R
authors.lastname: Bailey
authors.forename: John B
authors.initials: JB
authors.lastname: Weigele
authors.forename: Robert W
authors.initials: RW
authors.lastname: Hurst
authors.forename: Michael F
authors.initials: MF
authors.lastname: Stiefel
mesh_terms: D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000628:therapy*; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011145:Polyvinyls; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011859:Radiography; D013635:Tantalum; D016896:Treatment Outcome
chemical_list: D004338:Drug Combinations; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum