New research has shown that Onyx (ev3/Covidien), known for its unique properties of being less adhesiveand polymerising slowly, was able to stop acute bleeding in 13 out of 14 cases when used extracranially. While Onyx was developed for use in the embolization of central nervous system, it is increasingly being used extracranially.
A paper by Ruth Thiex et al, published earlier this year in the American Journal of Neuroradiology, reviewed the Boston experience and results with the use of Onyx for the treatment of fast-flow extracranialvascular lesions.
Thiex is from the Departments of Radiology and Neurosurgery, Brigham and Women’s Hospital, Boston, USA.
The investigators retrospectively analysed clinical and imaging records of 22 patients who underwent 71 extracranial embolizations from March 2007 through January 2010. They write that diagnoses were: cervicofacial arteriovenous malformation (n=18), traumatic fistula (n=3), and vessellaceration (n=1). In 87% (62/71 cases), Onyx was thesole embolic agent, delivered transarterially in 67/71 and percutaneously in the other four procedures.
The authors wrote that the clinical goals included amelioration of pain and control of bleeding. They judged the clinical efficacy of embolization by symptom control. The adverse events were assessed by clinical examination and history, both post-embolization and four weeks post-procedure.
Thiex et al found that cessation of acute bleeding was achieved in 13/14 cases, with one case of immediate recurrent massive epistaxis which called for re-intubationand further embolization. They controlled sub-acute bleeding episodes and pain for all patients. After staged embolization, seven patients underwent surgical resection without significant blood loss.
They write that surgeons reported high satisfaction with the intra-operative handling properties of Onyx. In terms of complications, the researchers saw transient swelling, local tenderness,or numbness after seven procedures. There were no stuck catheters, vessel dissections, or vessel ruptures and no skin discolouration.
The authors of the study concluded that staged Onyx embolization was clinically efficacious in managing extracranial fast-flow vascular malformations and lesions, with low associated morbidity.