Outcomes of Type II Endoleak Treatment Using Ethylene Vinyl Alcohol Copolymer (Onyx)
Brandon Nuckles, MD, Luis Nadal, Umar Tariq, MD, Ravi Kagali, MD, Andrea Berger, BA, James Elmore, Evan Ryer, MD
Geisinger Medical Center, Danville, PA
OBJECTIVES: The purpose of our study is to report our experience with the use of an ethylene vinyl alcohol copolymer (Onyx) for the treatment of type II endoleak after endovascular repair of abdominal aortic aneurysms (EVAR).
METHODS: Clinical data of all patients treated for type II endoleak following EVAR between 2009 and 2017 were retrospectively analyzed. Patient demographics and peri-operative data were summarized and standard statistical analysis performed. Abdominal aortic aneurysm (AAA) diameter and AAA sac volume during follow-up was measured using computed tomography angiography (CTA). Treatment failure variables were created for the change in sac diameter and volume. An increase in sac diameter ≥ 5mm was considered a failure, as was an increase ≥ 10% in AAA sac volume.
RESULTS: 35 patients (86% male) with a mean age of 74.5 years underwent treatment for a persistent type II endoleak following EVAR. Of these patients, 11 (31%) were treated with Onyx monotherapy, 7 (20%) were treated with Onyx and coil ± glue embolization, and 17 (49%) had coil ± glue embolization alone. There were no significant differences between the two groups with regards to age, BMI, or sex. The interval between EVAR and endoleak treatment was a mean of 40.7 months. A trans-lumbar approach was used in all 35 patients (100%). The average volume of Onyx used per treatment was 13.4mL (range 4.5ml- 39ml). Duration of CTA imaging follow-up was a mean of 29 months (range 1 - 76). Subgroup analysis revealed a significant difference between the groups in regards to change in sac volume when failure was defined as ≥ 10%. No patients treated with Onyx monotherapy had a sac volume increase ≥ 10%, whereas 3 patients (42.9%) treated with Onyx and coils ± glue, and 2 patients (11.8%) treated with coils ± glue alone had a sac volume increase ≥ 10% (p = 0.04). Complications included migration of embolization glue. All complications were without major clinical sequelae.
CONCLUSIONS: Onyx co-polymer embolization is safe and effective in the treatment of type II endoleak after EVAR. The use of Onyx embolization is associated with greater long-term success when compared with coil ± glue embolization.
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