Onyx versus coil embolization for the treatment of type II endoleaks.
J Vasc Surg. 2020 Nov 26;:
Authors: Scallan O, Kribs S, Power AH, DeRose G, Duncan A, Dubois L
OBJECTIVE: There is little evidence supporting the optimal treatment of type II endoleaks associated with aortic sac growth. Previous studies have lacked comparisons between treatment methods and long-term follow-up. The purpose of this study was to review our center’s experience with the treatment of type II endoleaks comparing Onyx (a liquid embolization agent consisting of ethylene vinyl alcohol) embolization with coil embolization.
METHODS: A retrospective review of a prospectively collected vascular surgery database was performed to identify all patients who underwent embolization of a type II endoleak for aortic sac growth after EVAR between 2005 and 2018. Onyx and coil embolization groups were compared using univariate statistics.
RESULTS: In total, 58 patients underwent 77 embolizations for type II endoleaks with either Onyx (27 patients, 37 procedures) or coils (31 patients, 40 procedures). The average aneurysm size at the time of embolization was larger in the Onyx group (77.9mm±15.1) compared to coil embolization (73.4mm±11.9). Mean follow-up was 57 months in the Onyx group and 74 months in the coil embolization group. Among the 27 patients undergoing Onyx embolization, two patients (7.4%) required graft explantation compared to five patients (16.1%) among the 31 patients undergoing coil embolization (p=.33). Based on per-patient analysis, the coil embolization group had a significantly higher rate of need for further reinterventions compared to the Onyx group (55% vs 19%, p<.01). Clinical success was observed in 13 (48%) of the Onyx embolization group compared to 10 (32%) of the coil embolization group (p=0.04). Two patients in each group presented with secondary rupture of the aneurysm sac following attempted embolization.
CONCLUSIONS: Type II endoleaks associated with sac growth treated with Onyx are less likely to require further reinterventions than with coil embolization, and there is a trend towards greater need for EVAR explant following coil embolization. With a high rate of further reintervention and potential for sac rupture, diligent follow-up is required after attempted type II embolization regardless of technique.
PMID: 33249208 [PubMed – as supplied by publisher]