Abstract No. 390 Feasibility, safety, and efficacy of in-line balloon occlusion assisted delivery of ethylene-vinyl alcohol copolymer (Onyx) for peripheral arterial applications: a multicenter case series

Abstract

To assess the feasibility, safety, and efficacy of balloon-assisted delivery of ethylene vinyl alcohol copolymer (EVOH) for peripheral arterial applications. Six major academic medical centers entered retrospective data on 46 consecutive patients, 60 procedures. Clinical indications included a wide range of vascular pathologies (most commonly, arteriovenous malformations, renal angiomyolipomas, and acute hemorrhage) and targeted peripheral arteries, both visceral and musculoskeletal. Data collected included gender, age, clinical indication, arterial pathology, arteries embolized, type of occlusion balloon microcatheter, type and concentration of EVOH agent, effectiveness as an embolic backstop, vessels protected, adequacy of EVOH cast penetration, catheter extraction, nontarget embolization, complications, and clinical outcome. Balloon occlusion prevented EVOH reflux in 59/60 (98.3%) procedures. Nontarget EVOH embolization occurred in 2 (3.3%) procedures. Adequacy of EVOH cast penetration and filling of the target pathology was complete in 57/60 (95%) procedures. Balloon deflation and easy extraction without attached EVOH fragments occurred in all procedures. Symptom reduction, cessation of bleeding, or lack of enhancement of subsequent imaging occurred in 41/45 (91.1%) patients with clinical follow-up. One major and two minor complications occurred. Balloon-assisted EVOH embolization of peripheral arteries is feasible, safe, and effective. The primary advantage of balloon-assisted EVOH embolization is the ability to safely apply more injection pressure in order to advance the EVOH cast assertively into the pathologic structure(s) and terminate EVOH advancement instantaneously.