Vinyl Alcohol Copolymer Research Articles

Coil or Plug-Assisted Ethylene Vinyl Alcohol Copolymer (EVOH) Thoracic Duct Embolization in the Treatment of Postoperative Chylothorax

Eleven patients (5 men, 6 women) with post-operative thoracic duct injuries and high output chylothorax were treated with thoracic duct embolization (TDE). Six patients underwent intraprocedural thoracic duct ligation at the time of original procedure. In all cases, the pleural fluid demonstrated high triglyceride levels (414 mg/dL; interquartile range [IQR], 345 mg/dL). Median daily (IQR) chest tube outputs before and after TDE were 900 mL (1,200 mL) and 325 mL (630 mL), respectively. Coil- or plug-assisted ethylene vinyl alcohol (EVOH) copolymer was used as embolic agent in all patients. Technical and clinical success rates were 100% and 82%, respectively. Nontarget venous embolization of EVOH copolymer was not identified on subsequent imaging.

Non-target embolic events during prostatic embolization with ethylene vinyl alcohol copolymer (EVOH)

BackgroundThis study evaluated nontarget embolization (NTE) during prostatic artery embolization (PAE) with ethylene vinyl alcohol copolymer (EVOH).ResultsTen consecutive patients treated by PAE with EVOH for the presence of disabling benign prostatic hyperplasia (BPH)-related lower urinary tract symptoms (LUTS) between June 22 and January 2023 were included in this prospective study. The inclusion criteria were as follows: LUTS attributed to BPH, LUTS duration ≥ 6 months, failure to respond to standard pharmacotherapy, IPSS > 18 or QoL score > 2, and prostate volume > 40 mL. Embolization was performed under general anaesthesia. According to established techniques, a microcatheter was positioned bilaterally within the feeding arteries, and EVOH was injected slowly under X-ray control. Unenhanced pelvic computed tomography scans were carried out before and after embolization to assess the NTE. The safety of the prostatic embolization procedure with EVOH was assessed by collecting adverse effects over 3 months of evaluation that included the International Prostate Symptom Score (IPSS) and quality of life (QoL) score.-up evaluations, occurring at 3, 6, and 12months, included International Prostate Symptom Score.Bilateral PAE was technically successful in 9 patients, and unilateral injection was performed in one patient. The postoperative scanner showed a distribution of the embolization material in the two lobes of the prostate in all patients. The procedure time varied from 120 to 150 (mean: 132) minutes. Eight out of 10 patients developed pollakiuria within 24 h; none of the patients had postoperative pain. Two patients required catheterization for postoperative urinary retention. Catheters were removed successfully at the end of the first day for one of these patients and on the tenth day for the other. At the 3-month follow-up, patients showed significant improvement in the International Prostate Symptom Score (n = 10; mean = -11,5; P < 0.01) and quality of life score (n = 10; mean = -3,40; P < 0.01). Only one patient presented one asymptomatic muscular NTE.ConclusionsPAE with EVOH is safe, effective, and associated with few NTEs and no postoperative pain. Prospective comparative studies with longer follow-ups are warranted.Trial registrationIDRCB, 2021-AO29-56–35. Registered 27 May 2022, http://clinicaltrials.gov/study/NCT05395299?cond=embolization&term&rank=1.

Environmental Consequences of Shelf Life Extension: Conventional versus Active Packaging for Fresh-Cut Salads

The use of active coatings in fresh food packaging is an innovative technique that optimizes the functional properties of films, resulting in a longer product shelf life and reduced food waste. But, which is more sustainable, active packaging (AP) or conventional packaging (CP) for the packaging of fresh-cut products? To answer this research question, this study analyzes the environmental performance of AP during its life cycle for packaging a minimally processed fresh salad mix compared with CP, in terms of its manufacture and use. The AP is a bag that includes a bioactive component, oregano essential oil (OEO), which is an inhibitor of microbial growth, incorporated into an ethylene vinyl alcohol copolymer (EVOH) coating on a conventional polypropylene (PP) film. To this end, a Life Cycle Assessment (LCA) was carried out based on ISO 14040 and 14044, using the ReCiPe methodology. The results showed that using active packaging has a beneficial affect, reducing the amount of produced food by 30% compared with conventional packaging over the same period. The reductions in the studied impact categories were greater than 50% in most of them, with a 62% reduction in global warming. The proposed sensitivity analysis showed the difference between the disposal or treatment of waste generated by the packaging production process and the packaged product, indicating that this step is of great importance for the environmental impacts and sustainability of this process. In 80% of the scenarios analyzed, the AP achieved better results than the CP in terms of damage categories.

Facile preparation of composite antimicrobial Al2O3 particles

Antimicrobial particles can inhibit or kill microorganisms, and have been widely used as antimicrobial filler in coatings and polymers. Herein, we present a facile method to prepare antimicrobial alumina particles by grafting epoxypropyl dimethydodecyl ammonium chloride (EPDDMAC) on γ-Al2O3 or ethylene–vinyl alcohol copolymer (EVOH) coated α-Al2O3.The results show that EPDDMAC can be grafted on γ-Al2O3 or EVOH-coated α-Al2O3 particles effectively, and the grafting rate rises with the increased EPDDMAC amount. The grafted composite particles exhibit excellent antibacterial properties against Escherichia coli and display great potential in antibacterial applications.

Repair of Isthmocele Following Embolization of Uterine Arteriovenous Malformation

To present a case of concurrent uterine arteriovenous malformation (AVM) and isthmocele, treated with ethylene vinyl alcohol copolymer (EVAC) embolization of the AVM followed by robotic isthmocele repair. A stepwise video demonstration with narration. A tertiary care academic hospital. Patient is a 37-year-old with one previous cesarean section who presented with persistent heavy vaginal bleeding after a dilation and evacuation procedure. Imaging showed evidence of an isthmocele and an iatrogenic uterine AVM secondary to the dilation and evacuation procedure. Both entities are morbid conditions associated with significant operative blood loss. Embolization of the acquired AVM was first performed to stabilize bleeding. In addition, owing to the extensive uterine defect and history of infertility, surgical repair of the isthmocele was recommended. A multidisciplinary approach combining interventional radiology and gynecologic surgery expertise, implementing several strategies to minimize blood loss: 1. Image-guided uterine AVM embolization with EVAC [1] 2. Hysteroscopic identification of isthmocele and residual EVAC in the cavity, with fluorescence transillumination to clearly delineate isthmocele borders 3. Robot-assisted laparoscopic approach for bladder flap creation, as well as retroperitoneal space dissection to skeletonize uterine arteries 4. Transient occlusion of uterine arteries using vascular clamps to minimize operative blood loss given the isthmocele size and its proximity to the left uterine artery 5. Resection of the isthmocele and removal of residual intracavitary EVAC 6. Multilayer, bidirectional hysterotomy closure and vascular clamp removal to restore uterine blood supply CONCLUSIONS: Successful multidisciplinary treatment of concurrent uterine AVM and isthmocele. Cesarean delivery at 36 to 37 weeks' gestational age was recommended for future deliveries.

Soluble vs Non-Soluble Support Materials for Bone 3D Printed Anatomical Models: A Comparison on Production Time, Cost and Finish Quality

3D anatomical models play an increasing important role in the 3D surgical planning area allowing specialists to have an anatomical representation of the patient before the intervention. The support material to print models is fundamental to ensure optimal finishing, which is why soluble support is a good option for these cases. BVOH (butanediol vinyl alcohol copolymer) is a water-soluble thermoplastic optimized for support generation on FDM (fuse deposition modelling) printing process. In addition, PVA (polyvinyl acetate) is another well-known soluble thermoplastic used for support generation. Compared to PVA, BVOH has some benefits and improvements such as better surface quality, solubility times and ease of printing resulting in a better finish of the model. In this study, we have compared the time and cost of printing the same case combining PLA or ABS with BVOH for the generation of support material and the same printing with supports of the same printing material. The obtained results show an increase in cost and printing time of 33 % with respect to printing with conventional supports. However, this increase in cost and time is offset by the finishes obtained; obtaining much better results compared to the use of non-soluble material to generate the support. It also represents an increase in productivity since for the post-processing of the piece it is only necessary to leave it in water for approximately 22min at a temperature of 50°C or 45min at a water temperature of 22°C. Moreover, compared to PVA, BVOH has shorter solubility times.Furthermore, in the cases where it is necessary to generate internal support, soluble support is the best option since it will be removed with water without leaving visible marks.In conclusion, the use of soluble support presents a clear advantage in terms of finish and increased performance of the 3D printing staff (i.e reduce the time that a person needs to speed removing non-soluble support material), but on the other hand, it presents an increase in cost and printing time.

Crystallization Kinetics of Ethylene Vinyl Alcohol Copolymer Revealed by Fast Scanning Chip Calorimetry Analysis

Crystallization Kinetics of Ethylene Vinyl Alcohol Copolymer Revealed by Fast Scanning Chip Calorimetry Analysis

Middle Meningeal Artery Embolization for Subdural Hematoma: An Institutional Cohort and Propensity Score-Matched Comparison with Conventional Management

BackgroundThe treatment of non-acute subdural hematoma (NASDH) is challenging due to its high recurrence rates and comorbidities of mostly elderly patients. Middle meningeal artery embolization (MMAE) recently emerged as an alternative to surgery in the treatment of NASDH. ObjectiveTo describe a single center’s experience of MMAE with Onyx for NASDH and compare it to a surgically treated historical cohort. MethodsWe performed a retrospective analysis of patients undergoing MMAE for NASDH from 2019 to 2021. MMAE was performed with ethylene vinyl alcohol copolymer (Onyx). Comparisons were made with a historical cohort from 2010 to 2018 who underwent surgical evacuation only, before and after propensity score matching. Outcomes were assessed clinically and radiographically. ResultsWe included 44 consecutive patients (55 MMAEs) who underwent MMAE, with a median follow-up of 63.5 days. Twenty-four NASDHs underwent upfront embolization, 17 adjunctive, and 14 for recurrence after prior surgical evacuation, with no significant differences in hematoma and mRS reduction between them. Two patients died during hospitalization and 2 during follow-up, unrelated to the procedure. Mean SDH thickness decreased by 48.3% ± 38.1% (P < 0.001) on last follow-up, which did not correlate with the amount of Onyx injected. Six (13.6%) patients required surgical rescue after embolization. There were no procedure-related complications. The mean modified Rankin Scale (mRS) on admission was 2.8 ± 1.5, which decreased significantly to 1 [1,4] at the last follow-up (P = 0.033). The MMAE (41 hematomas; upfront and adjunctive embolization) and Surgical Evacuation-only (461 hematomas) cohorts were balanced with propensity score mathing. Matching was successful for 41 MMAE and 41 surgical-only hematoma pairs, and only hypertension remained significantly different between the two groups, but there was no significant difference in any outcome. ConclusionMMAE for NASDH seems safe and effective in appropriately selected patients, non-inferior to surgery, and may become a minimally-invasive alternative. Given our encouraging results, large-scale clinical randomized trials are warranted.

Prediction of water vapor permeation and desiccant saturation in vacuum insulation panels with a glass fiber core

The permeation of dry air in vacuum insulation panels (VIPs) with a glass fiber core has been often prevented using laminated films with metallized ethylene vinyl alcohol copolymer (EVOH) layers; meanwhile, desiccants are incorporated to control the increasing pressure due to the permeation of water vapor. Previously proposed models can predict the changes in long-term performance caused by dry-air permeation, but a method that accounts for water-vapor permeation and desiccant saturation has not been reported before. Predicting the long-term performance of VIPs when exposed to outdoor temperature and humidity is essential for using it as a building insulation material. In this study, we investigated the dependence of the water-vapor transmission rate (WVTR) of metallized EVOH film on temperature and relative humidity, and the effect of ambient water-vapor pressure on the WVTR of metallized EVOH film. To reduce the measurement time of WVTR, we developed a new measurement method using a small sensor device and confirmed that its accuracy is equivalent to that of the conventional method. We measured the water-vapor transmission coefficient of glass fiber core VIPs under various temperature and humidity conditions using this measurement method. For the same water-vapor pressure, the amount of transmission significantly depended on the temperature and humidity conditions. Therefore, the WVTR of metallized EVOH films should be more concerned with the effect of relative humidity than that of the water vapor pressure of the ambient air. Based on these results, a new model that accounts for desiccant saturation was proposed and validated based on the conventional model to predict the long-term performance under permeation of mixed gases. The new model accurately evaluated the long-term performance of VIPs with confirmed desiccant saturation, supporting the long-term performance of glass fiber core VIPs.

Effectiveness Evaluation of Preventive Embolization of the Internal Iliac Artery in Preventing Type II Endoleaks.

Purpose The aim of this study was to evaluate the effectiveness of the proposed method of preventive embolization of the internal iliac arteries using a liquid tantalum-containing ethylene vinyl alcohol copolymer. Methods In this nonrandomized clinical study with a retrospective control group, 55 patients with aneurysmal lesions of the infrarenal abdominal aorta participated. In the course of this study, we developed and implemented a method of preventive embolization of the ostia of the internal iliac artery using a liquid tantalum containing ethylene-vinyl alcohol copolymer having viscosity of 34 centipoise. The method was applied in 27 cases in patients with aneurysmal lesions of the infrarenal abdominal aorta with unilateral involvement of the common iliac artery. The maximum follow-up period at the stage of publication of the results was 24 months. Results The proposed method of embolization of the internal iliac artery is accompanied by an absolute risk of developing type II endoleak 0.393 (95% confidence interval: 0.2120-0.5738, p = 0.029); therefore, when using the new technique, there is a decrease in the absolute risk of developing type II endoleak by 39.3%. Conclusion The proposed method of preventive embolization allows to perform reliable occlusion of the internal iliac artery as proximally as possible, which makes it possible to maintain distal blood flow in the internal iliac artery and minimizes the risks of ischemic events.

The impact of storage temperature and packaging material on the quality of ultrasound treated sweet lime juice

The aim of this study is to examine the shelf life of ultrasound (US) treated sweet lime juice at 4, 15, 25, 30, and 35 °C and in two different packaging materials (coextruded ethylene vinyl alcohol copolymer [EVOH] and multi-layered polyethylene terephthalate [ML-PET] films). The US-treated sweet lime juice (0.7 W/cm3) was analyzed for the microbial count, enzyme activity, bioactive compounds degradation, and sensory attribute for a shelf-life of 37 days. Different packaging materials and storage temperatures had a significant effect (p < 0.05) on the microbial, enzyme inactivation, and biochemical attributes but had no significant influence (p > 0.05) on pH, acidity, and soluble solids in the samples. On a zeroth day, the US-treated sample showed an increase in bioactive compounds and vitamin C due to the increased cavitation effect. US-treated juice (0.7 W/cm3) retained 88.8% vitamin C and 100% antioxidants after 37 days of storage at 4 °C. Untreated and US-treated juice (0.7 W/cm3 at 0 day) got sensory scores of 8.1 and 7.5 out of 9 respectively. The juice stored in ML-PET had a better shelf life and nutrient retention than in the EVOH pouch. Interestingly, the sensory and vitamin C profile was above the allowable limit even after 37 days of storage. However, the microbiological count (>6 log cfu/mL) limited shelf life up to 37, 17, 11, 5, and 3 days, at 4, 15, 25, 30, and 35 °C for the juice packed in ML-PET pouch.

Fine adjustment of emission wavelength, light-conversion quality, photostability of blue-violet light conversion agents based on FRET effect

Single fluorescent chromophore is difficult to achieve efficient photoecological effect, meanwhile, the cost of light conversion agent should be more strictly controlled, thereby promoting the large-scale application of light conversion agricultural film. To solve the above problems, three carbazole derivatives CZ, TCZ and MCZ as donors of Förster resonance energy transfer, and the tris(carbazolyl) substituted triazine TPT as an acceptor of Förster resonance energy transfer, were designed and synthesized. Based on absorption and emission spectra, aggregation induced emission experiments, and light conversion quality tests, the best formulation of light conversion film are obtained. Among of them, TCZ@0.2TPT@EVAb and MCZ@0.2TPT@EVAb films (40% ethylene vinyl alcohol copolymer defined as EVAb film) show highest photosynthetic photon flux density at 400–500 nm, and matching fluorescence emission (458 nm and 461 nm). Under 20 h of intensified ultraviolet radiation (365 nm, 40 W), the emission intensity of TCZ@0.2TPT@EVAb and MCZ@0.2TPT@EVAb films can maintain over 94% of the initial value, showing excellent photostability. Compared with the blank EVAa/EVAb film, the transmittance of the doping films at 500–600 nm are up to 95.12%–99.64%, meaning excellent compatibility and dispersion of light conversion agent in doping films. It is worth mentioning that emission maxima of doping films can be continuously adjusted within the spectral range 430–480 nm, which is conducive to meet the photoecological needs of different crops. Finally, the doping films show low transmittance (1.78%–11.42%) at 200–350 nm, outlining excellent UV light conversion properties.

Safety, Efficacy and Mid-Term Outcome for Transarterial Embolization (TAE) of Renal Angiomyolipoma (AML) Using Ethylene Vinyl Alcohol Copolymer Liquid Embolic Agent (EVOH).

Transarterial embolization (TAE) of renal angiomyolipoma (AML) is effective in treating and preventing hemorrhage. We report our experience using EVOH with a single-center retrospective study of all AML embolized with EVOH between June 2013 and March 2022 at the Montpellier University Hospital. A total of 29 embolizations were carried out in 24 consecutive patients (mean age: 53.86 years; 21 women and 3 men) with 25 AMLs for severe bleeding, symptomatic AML, tumor size > 4 cm, or presence of aneurysm(s) > 5 mm. Data collected included imaging and clinical outcomes, tuberous sclerosis complex status, change in AML volume, rebleeding, renal function, volume and concentration of EVOH used, and complications. Out of 29 embolizations performed for 25 AMLs, four were performed in an emergency. Technical success was achieved for 24/25 AMLs. Mean AML volume reduction was 53.59% after a mean follow-up time of 446 days using MRI or CT scan. Aneurysms on angiogram and the symptomatological nature of AML, as well as secondary TAE and multiple arterial pedicles, were statistically associated (p < 0.05). Two patients (8%) underwent nephrectomy after TAE. Four patients had a second embolization. Minor and major complication rates were 12% and 8%, respectively. Neither rebleeding nor renal function impairment was noticed. TAE of AML using EVOH is, thus, highly effective and safe.

Morphology and Properties of Polylactic Acid Composites with Butenediol Vinyl Alcohol Copolymer Formed by Melt Blending.

Due to its poor toughness and hydrophilicity, the application of polylactic acid (PLA) in the field of absorbent sanitary materials is restricted. A butenediol vinyl alcohol copolymer (BVOH) was used to improve PLA via melt blending. The morphology, molecular structure, crystallization, thermal stability, tensile property, and hydrophilicity of PLA/BVOH composites with different mass ratios were investigated. The results show that the PLA/BVOH composites possessed a two-phase structure with good interfacial adhesion. The BVOH could effectively blend into PLA without a chemical reaction. The addition of the BVOH promoted the crystallization of PLA, improved the perfection of the crystalline region, and increased the glass transition temperature and melting temperature of PLA in the heating process. Moreover, the thermal stability of PLA was markedly improved by adding the BVOH. The addition of the BVOH also had a significant effect on the tensile property of the PLA/BVOH composites. When the content of the BVOH was 5 wt.%, the elongation at the break of the PLA/BVOH composites could reach 9.06% (increased by 76.3%). In addition, the hydrophilicity of PLA was also significantly improved, and the water contact angles decreased with the increase in the BVOH content and time. When the content of the BVOH was 10 wt.%, the water contact angle could reach 37.3° at 60 s, suggesting good hydrophilicity.

Use of Ethylene Vinyl Copolymer for Embolization Outside the Central Nervous System: A Case Review.

Onyx (ethylene vinyl copolymer; Medtronic, Minneapolis, MN) is a nonadhesive, nonabsorbable, permanent liquid embolic agent. It is Food and Drug Administration (FDA) approved for preoperative embolization of brain arteriovenous malformations (AVMs). Onyx is composed of an ethylene vinyl alcohol (EVOH) copolymer, dimethyl sulfoxide (DMSO), and micronized tantalum powder. Each substance plays a vital part in the overall effectiveness and delivery at embolization. EVOH is the embolic component and DMSO facilitates delivery through the catheter by acting as a solvent. Micronized tantalum powder allows radiographic visualization. Onyx is available in two concentrations: Onyx 18 (6% EVOH) and Onyx 34 (8% EVOH). Onyx 18 has lower viscosity which allows for greater downstream flow from the delivery microcatheter.

Morphological evolution ofTMB‐5/ethylene–vinyl alcohol copolymer blends under biaxial‐stretching field and its effect on the crystallization and gas barrier properties of isotactic polypropylene

AbstractThe morphological evolution of TMB‐5/ethylene–vinyl alcohol (EVOH) copolymer blends under biaxial‐stretching field and its effect on the crystallization and gas barrier properties of isotactic polypropylene (iPP) were investigated. iPP/TMB‐5/EVOH ternary blends with TBM‐5 selectively distributed in the EVOH phase were prepared through a multistage stretching extrusion, which combined an assembly of layer multiplying elements (LMEs) with an extruder. Scanning electron microscopy revealed that the biaxial‐stretching field in LMEs transformed the TMB‐5/EVOH phase into platelets along the extrusion direction. Differential scanning calorimetry and X‐ray diffraction results indicated that the TMB‐5 particles were distributed in the EVOH phase and noβcrystals formed in as‐extruded samples. Especially, the TMB‐5 was released from the EVOH phase into iPP in the annealing process and induced the formation ofβcrystals. Compared with that of pure iPP, the oxygen permeability coefficient of iPP containing aligned TMB‐5/EVOH platelets decreased more than three times. The enhanced barrier properties resulted from the increased tortuosity of the diffusion pathway caused by the orientated high‐aspect‐ratio platelets. © 2023 Society of Industrial Chemistry.

Abstract Number ‐ 97: Middle meningeal artery embolization to treat chronic subdural hematomas – Retrospective study of morphological parameters

Introduction Chronic subdural hematomas are a common neurovascular condition that involve the gradual and continual exudation of fluid from a compromised cell layer lining the dura [1]. Embolization of the middle meningeal artery (MMAE) results in lower recurrence rates as compared to traditional surgical burr hole evacuation [2‐4]. Liquid embolic agents such as cyanoacrylates or ethylene vinyl alcohol copolymers can potentially provide a distinct advantage with greater distal penetration resulting in faster hematoma resolution [5]. Their inherent radiopacity (after pre‐mixing) also allows for accurate visualization and control over embolization. The hypothesis of this study is that liquid embolic surface area would correlate with more effective cSDH volume resolution in patients. Methods Under IRB approval, we retrospectively analyzed non‐contrast head CTs and immediate post‐embolization flat‐detector CTs from 45 patients who underwent first‐line MMAE with a liquid embolic. Patients who received any neurosurgical intervention were excluded. 3D‐Slicer was used to segment and calculate hematoma volumes pre‐embolization, as well as at 1‐month, 3‐months, and 6‐months post‐embolization. The flat‐detector CT scans were also segmented to calculate the surface area of the liquid embolic. Results There was significant reduction in hematoma volume at 1‐, 3‐ and 6‐months with respect to the preoperative cSDH volume (Figure A, Pre: pre‐treatment, mo: month). The liquid embolic surface area significantly correlated with (a) pre‐embolization hematoma volume (R2 = 0.27, p = 0.0002, n = 45), (b) the reduction in volume at 1‐month post‐embolization (R2 = 0.16, p = 0.007, n = 41), (c) volume reduction at 3‐months post‐embolization (R2 = 0.29, p = 0.0015, n = 32), (d) hematoma volume resorption rate (cc/day) calculated at 1‐month post‐embolization (R2 = 0.16, p = 0.011, n = 39), and (e) hematoma volume resorption rate calculated at 3‐months post‐embolization (R2 = 0.34, p = 0.0003, n = 34, Figure B). The liquid embolic surface area was not correlated to the volume reduction at 6‐months (p = 0.3, n = 26). Conclusions The luminal surface area of MMA vasculature embolized with liquid embolics may be correlated to the reduction in cSDH volumes. The liquid embolic segmentation method used here needs further refinement to improve accuracy. Additional data sets are required to confirm the correlations reported here.

EMBOLIZATION OF THE INTERNAL ILIAC ARTERY USING LIQUID EMBOLYZING SYSTEMS

Among the complications of endovascular abdominal aortic aneurysm repair the most common are the so–called endoleaks - the preservation of blood flow inside an isolated aneurysmal sac. This complication occurs in almost every fourth patient and is the main cause of reinterventions, which makes the late development of this complication one of the urgent problems under discussions. The report presents a clinical case of treatment of a patient with an aneurysm of the infrarenal abdominal aorta with its spread to the common iliac artery using the technique of preventive embolization of the internal iliac artery with application of a liquid tantalum-containing ethylene vinyl alcohol copolymer. All stages of the operation were performed in the catheterization laboratory using a stationary angiographic system. The embolizing material was introduced after implantation of the stent-graft into the target position, through a microcatheter pre-installed at the ostium of the embolizing internal iliac artery. The introduction of a tantalum-containing ethylene vinyl alcohol copolymer after the installation of the stentgraft, under conditions of significant reduction of arterial antegrade blood flow in the lumen of the internal iliac artery, allowed to create a reliable occlusion of the ostium segment of the artery, reduced the risk of migration of embolizing substance into the distal arterial bed.

Management of carotid cavernous fistulas: A single center experience.

Multimodal endovascular therapy (EVT) of carotid cavernous fistula (CCF) with different approaches and a variety of available embolization material enable high occlusion rates with good clinical and functional outcome but until now there is still little evidence available. This retrospective single-center study aims to evaluate EVT of CCF with different neuroendovascular techniques regarding occlusion rates, complications and outcomes. From 2001 to 2021 59 patients with CCF were treated at our tertiary university hospital. Patient records and all imaging data including angiograms were reviewed for demographic and epidemiological data, symptoms, fistula type, number of EVTs, complications of EVT, type of embolic materials, occlusion rates and recurrences. Etiology of the CCF were spontaneous (41/59, 69.5%) post-traumatic (13/59, 22%) and ruptured cavernous aneurysms (5/59, 8.5%). Endovascular therapy was completed in one session in 74.6% (44/59). Transvenous access was most frequent (55.9% 33/59) followed by transarterial catheterization in 33.9% (20/59) and a combination of both (6/59, 10.2%). Exclusively coils were used in 45.8% (27/59), a combination of ethylene vinyl alcohol (EVOH) copolymer (Onyx) and coils in 42.4% (25/59). Complete obliteration was achieved in 96.6% of patients (57/59) with an intraprocedural-related complication rate of 5.1% (3/59) and no mortality. Endovascular therapy of CCF has been shown to be safe and effective with high cure rates and low rates of intraprocedural complications and morbidity even in complex scenarios.

Parapharyngeal Space Tumors: Our Experience.

Para-pharyngeal space (PPS) tumors include an heterogeneous group of neoplasms, accounting for approximatively 0.5-1.5% of all head and neck tumors. Management of these neoplasms requires a careful diagnostic workout and an appropriate surgical approach to obtain good outcomes associated with minimal aesthetic drawbacks. In this study we investigated clinical onset, histologic features, surgical treatment outcomes, peri operative complications and follow up of 98 patients treated for PPS tumors in our Centre between 2002 and 2021. Furthermore, we reviewed our preliminary experience of preoperative embolization of hyper vascular PPS tumors trough SQUID12, an ethylene vinyl alcohol copolymers (EVOH) which exhibits many advantages over other embolic agents, due to its better devascularization rate and lower risk of systemic complications. Our data support the hypothesis that transoral surgery scenario should be significantly revised, as it could represent a valid treatment for tumors located in lower and prestyloyd portion of PPS. Moreover, SQUID12, a novel embolization agent, may be a very promising choice for PPS hyper vascularized tumors, ensuring higher devascularization rate, safer procedures and lower risk of systemic dispersion compared to traditional Contour treatment.