Abstract
BackgroundSquid, as Onyx, is an ethylene-vinyl alcohol copolymer (EVOH)-based liquid embolic agent developed for neuroradiologic interventions with poor application in abdominal district. Our aim was to evaluate safety, complications, and efficacy of transcatheter embolization using the two available formulations Squid-18 and 12, in 30 patients affected by different abdominal diseases.ResultsTranscatheter embolization with Squid, combined with other embolic agents, as poly vinyl alcohol (PVA) particles, coils and amplatzer plugs, or alone (type 2 endoleak), was performed in 30 patients, as follows: 10 portal vein embolizations (PVEs), 6 arteriovenous malformations (AVMs), 5 visceral artery aneurysms (VAAs), 4 type 2 endoleaks, 3 preoperative embolizations, 1 acute arterial bleeding, 1 female varicocele. Squid was always administered using dimethyl sulfoxide (DMSO) compatible microcatheters. Technical success, 30-day clinical success and complications were assessed.Technical success was 90%. 3 patients (2 AVMs, 1 VAA) required re-intervention successfully performed in all cases. Major complications, cases of microcatheter entrapment and DMSO-related poor pain control were not recorded. 30-day clinical success was 93.3%: in 2 patients submitted to PVE a sufficient future liver remnant (FLR) hypertrophy was not achieved.ConclusionSquid was successfully used with low complication rate in many abdominal diseases showing a valid embolic action either combined with other embolic agents or alone in type 2 endoleak. The availability of different formulations (Squid-18 and Squid-12) variable for viscosity makes Squid preferable to Onyx as EVOH-based liquid embolic agent, even though comparable studies in different abdominal districts with a larger cohort of patients will be necessary.
Highlights
Transcatheter embolization (TE) is a well-established technique in interventional radiology in which an occlusive agent is delivered through a catheter to obstruct flow within a targeted blood vessel (Sheth et al, 2017)
Using non adhesive liquid embolic agents composed of ethylene-vinyl alcohol copolymer (EVOH) copolymer dissolved in dimethyl sulfoxide (DMSO) and mixed with micronized tantalum powder, as Onyx, it is possible to obtain a slower solidification, a more prolonged injection time and a reduced risk of microcatheter entrapment than n-butyl cyanoacrylate (n-BCA)
General findings Thirty patients (16 females, 14 males, mean age = 59 years, age range = 24–88 years) affected by different abdominal diseases were submitted to embolization with Squid-Peri (Squid-18 in 15 cases, Squid-12 in 8 cases, Squid 18 + 12 in 7 cases) as follows: 10 cases of portal vein embolization (PVE) (Fig. 1), 6 cases of visceral artery aneurysms (VAAs) (Fig. 2), 5 cases of arteriovenous malformations (AVMs) (Fig. 3), 4 cases of type Type 2 endoleak (Fig. 4), 3 cases of pre-operative arterial embolization (Fig. 5), one case of female varicocele, and one case of emergency arterial bleeding following bone marrow biopsy (Fig. 6)
Summary
Transcatheter embolization (TE) is a well-established technique in interventional radiology in which an occlusive agent is delivered through a catheter to obstruct flow within a targeted blood vessel (Sheth et al, 2017). Squid is a new DMSO- and EVOH-based liquid embolic agent which has mainly been used in cerebral field (Akmangit et al, 2017; Gioppo et al, 2017) with poor application in abdominal district (Szatmáry et al, 2017). It is commercially available in Squid-12 (Szatmáry et al, 2017; Erbahceci et al, 2014) and Squid-18 forms. As Onyx, is an ethylene-vinyl alcohol copolymer (EVOH)-based liquid embolic agent developed for neuroradiologic interventions with poor application in abdominal district. Our aim was to evaluate safety, complications, and efficacy of transcatheter embolization using the two available formulations Squid-18 and 12, in 30 patients affected by different abdominal diseases
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