Abstract
This review focuses on the use of “new” generation of non-adhesive liquid embolic agents (NALEA). In literature, non-adhesive liquid embolic agents have mainly been used in the cerebral district; however, multiple papers describing the use of NALEA in the extracranial district have been published recently and the aim of this review is to explore and analyze this field of application. There are a few NALEA liquids such as Onyx, Squid, and Phil currently available in the market, and they are used in the following applications: mainly arteriovenous malformations, endoleaks, visceral aneurysm or pseudoaneurysm, presurgical and hypervascular lesions embolization, and a niche of percutaneous approaches. These types of embolizing fluids can be used alone or in combination with other embolizing agents (such as coils or particles) so as to enhance its embolizing effect or improve its possible defects. The primary purpose of this paper is to evaluate the use of NALEAs, predominantly used alone, in elective embolization procedures. We did not attempt a meta-analysis due to the data heterogeneity, high number of case reports, and the lack of a consistent follow-up time period.
Highlights
Therapeutic endovascular embolization is a well-established treatment both in cranial and extra-cranial districts with a wide variety of embolic devices available on the market
This review focuses on the use of liquid embolic agents and in particular those included in the non-adhesive category
Non-adhesive liquid embolic agents have mainly been used in the cerebral district; multiple papers describing the use ethylene vinyl alcohol copolymer (EVOH) in extracranial district have been published recently [2,3,4]
Summary
Therapeutic endovascular embolization is a well-established treatment both in cranial and extra-cranial districts with a wide variety of embolic devices available on the market. This review focuses on the use of liquid embolic agents and in particular those included in the non-adhesive category. This class includes all those new generation agents based on ethylene vinyl alcohol copolymer (EVOH) composition, Polyvinyl Alcohol (PVA) composition, and Polylactide-co-glycolide (PGC) and Hydroxyethylmethacrylate (HEMA) that have gained popularity due to their “magma-like” flow, enabling good control of the embolic material. We can make a first distinction between solid agents, such as coils or vascular plugs (including micro-plugs) that have two major advantages: the first is the ease of use and the second is the detachable control with possibility of repositioning; they have the limitation of poor immediate occlusive power. Solid agents include microparticles, which have the characteristic of being conveyed into the target vessel but are poorly controllable and have a discrete risk of migration
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