title: Treatment of type II endoleak using Onyx with long-term imaging follow-up.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, 22908, USA, irmdmba@me.com.
authors.forename: Minhaj S
authors.initials: MS
authors.lastname: Khaja
authors.forename: Auh Whan
authors.initials: AW
authors.lastname: Park
authors.forename: Warren
authors.initials: W
authors.lastname: Swee
authors.forename: Avery J
authors.initials: AJ
authors.lastname: Evans
authors.forename: J
authors.initials: J
authors.lastname: Fritz Angle
authors.forename: Ulku C
authors.initials: UC
authors.lastname: Turba
authors.forename: Saher S
authors.initials: SS
authors.lastname: Sabri
authors.forename: Alan H
authors.initials: AH
authors.lastname: Matsumoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D003487:Cyanoacrylates / Q000627:therapeutic use; D004121:Dimethyl Sulfoxide / Q000627:therapeutic use*; D004621:Embolization, Therapeutic / Q000379:methods; D057867:Endoleak / Q000628:therapy*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008026:Ligation; D008297:Male; D056687:Off-Label Use; D011145:Polyvinyls / Q000627:therapeutic use*; D019233:Retreatment; D012189:Retrospective Studies; D055989:Septal Occluder Device; D016896:Treatment Outcome
chemical_list: D003487:Cyanoacrylates; C450660:Onyx copolymer; D011145:Polyvinyls; D004121:Dimethyl Sulfoxide