E2957. Ethylene-Vinyl Alcohol Copolymer-Based Liquid Embolic Agent: From Neck to Toe
Authors
Antoine Khalil;
APHP- CHU Bichat Claude Bernard; University Paris Cité
Madalin Dobre;
APHP- CHU Bichat Claude Bernard
Selma Attia;
APHP- CHU Bichat Claude Bernard
Ahmed Tibaoui;
APHP- CHU Bichat Claude Bernard
Waqaas Mohammad;
APHP- CHU Bichat Claude Bernard
Background
The use of nonadhesive liquid embolic agent composed of ethylene-vinyl alcohol copolymer (EVOH)-based liquid embolic agent dissolved in dimethyl sulfoxide (DMSO) with suspended micronized tantalum powder has several advantages to achieve a more rapid and permanent vessel occlusion (comparing to coils), slower solidification with more prolonged injection time than n-BCA, and its nonadhesive properties permit more distal embolization without significant risk of catheter entrapment. The learning curve is very fast. Two commercial products are currently available, Onyx (Medtronic, Dublin, Ireland), and SQUID (Balt). The DMSO infusion is painful in systemic arteries embolization requiring the use of analgesic leading the limitation of its use. There are multiple indications for the use of these products in the periphery including arteriovenous mal-formations and hypervascular tumors, endoleaks, arteriovenous malformations, portal veins, and bleeding.
Educational Goals / Teaching Points
Mechanisms of action and advantages of the product (Onyx and Squid). How I use it with and without general anesthesia. How I use it in scheduled and emergency situations. How I manage bleeding: neck, thorax, abdomen, iatrogenic. How I manage scheduled embolization with thorax, visceral aneurysms, Uterine AVM.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
External carotid artery collaterals; subclvian artery collaterals; bronchial arteries/pulmonary arteries; renal arteries/hepatic artery/splenic artery; superior and inferior mesenteric arteries; uterine arteries; prostatic artery; femoral artery; bleeding artery; embolization and liquid.
Conclusion
Good knowledge of this embolization material provides an additional tool for embolization. This product can be used in patients under general or local anesthesia. The administration should be done slowly and discontinuously. Good control of the administration allows the product to be delivered as distally as possible without reflux or embolization of non-target arteries
