title: Safety and clinical efficacy of Onyx for embolization of extracranial head and neck vascular anomalies.
abstract: OBJECTIVE
  Onyx was developed for embolization of central nervous system AVMs but is increasingly used extracranially because of its unique physical properties. We review our experience and results with the use of Onyx for the treatment of fast-flow extracranial vascular lesions.
  
  
  METHODS
  We retrospectively analyzed clinical and imaging records of 22 patients who underwent 71 extracranial embolizations from March 2007 through January 2010. The diagnoses were the following: cervicofacial AVM (n = 18), traumatic fistula (n = 3), and vessel laceration (n = 1). In 62 of 71 procedures (87%), Onyx was the sole embolic agent; it was delivered transarterially in 67/71 and percutaneously in 4/71 procedures. Clinical goals included amelioration of pain and control of bleeding. The clinical efficacy of embolization was judged by symptom control, and adverse events were assessed by clinical examination and history, both postembolization and 4 weeks postprocedure.
  
  
  RESULTS
  Cessation of acute bleeding was achieved in 13/14 cases, with 1 case of immediate recurrent massive epistaxis prompting reintubation and further embolization. Control of subacute bleeding episodes and pain was achieved for all patients. Following staged embolization, 7 patients underwent surgical resection without significant blood loss. Surgeons reported high satisfaction with the intraoperative handling properties of Onyx. Transient swelling, local tenderness, or numbness was encountered after 7 procedures. There were no stuck catheters, vessel dissections, or vessel ruptures and no skin discoloration.
  
  
  CONCLUSIONS
  Staged Onyx embolization was clinically efficacious in managing extracranial fast-flow vascular malformations and lesions, with low associated morbidity.
authors: Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: R
authors: R
authors: Thiex
authors: I
authors: I
authors: Wu
authors: J B
authors: JB
authors: Mulliken
authors: A K
authors: AK
authors: Greene
authors: R
authors: R
authors: Rahbar
authors: D B
authors: DB
authors: Orbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004338:Drug Combinations; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006257:Head / Q000002:abnormalities* / Q000098:blood supply*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000002:abnormalities* / Q000098:blood supply*; D011145:Polyvinyls / Q000009:adverse effects* / Q000627:therapeutic use*; D013635:Tantalum / Q000009:adverse effects* / Q000627:therapeutic use*; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000628:therapy*; D055815:Young Adult
chemical_list: D004338:Drug Combinations; D006490:Hemostatics; C558446:Onyx 18; D011145:Polyvinyls; D013635:Tantalum