Ethylene-vinyl alcohol polymer trans-arterial embolization in emergency peripheral active bleeding: initial experience.
OBJECTIVE
The aim of this paper was to evaluate the efficacy, safety, and clinical outcomes of superselective embolization using ethylene-vinyl alcohol copolymer (Onyx Liquid Embolic System; ev3 Neurovascular, Irvine, CA, USA) as the primary treatment in active peripheral emergency arterial bleeding.


METHODS
Between January 2014 and June 2014, all patients with active peripheral arterial bleeding who were treated by embolization were retrospectively analyzed. We selected 15 (age 37-91 year old) patients embolized with Onyx, chosen as embolic agent in an intention-to-treat fashion. Multidetector computed tomography was performed in all patients.


RESULTS
Active bleeding was detected in all cases. Digital subtraction angiography confirmed CT findings in all cases. The causes of bleeding were traumatic in 8 patients, angiodysplasia in 1 patient, duodenal ulcer in 1, chronic pancreatitis in 1 and unknown in 4 patients. Nine patients were under anticoagulant or antiplatelet therapy. Embolization was possible in all patients. The technical success rate was 100%. The immediate bleeding control rate was 100%. No rebleeding at 30 days occurred (0%). There were no major complications, or deaths attributable to the treatment. No patient needed surgery or new embolization during a mean follow-up period of 5.1 months (range, 4.5-6 months).


CONCLUSIONS
Control of massive active peripheral emergency arterial bleeding using superselective embolization with Onyx is feasible and safe.
Unit of Interventional Radiology, Department of Radiology, Insubria University, Varese, Italy - gcarraf@gmail.com.
A M
AM
Ierardi
G
G
Xhepa
E
E
Duka
D
D
Laganà
A
A
Ianniello
C
C
Floridi
A
A
Bacuzzi
A
A
Reginelli
E
E
Squillaci
L
L
Brunese
G
G
Carrafiello
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D004621:Embolization, Therapeutic / Q000379:methods*; D004630:Emergencies; D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D058729:Peripheral Arterial Disease / Q000628:therapy*; D011145:Polyvinyls / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D011145:Polyvinyls; C020320:ethylene-vinyl alcohol copolymer