Percutaneous Embolization of Scalp Arteriovenous Malformation Using New Liquid Embolic Agent, SQUID: A Technical Report

AbstractScalp arteriovenous malformations (AVMs) are rare extracranial vascular malformations that are traditionally treated by surgical excision or by combined endovascular-surgical approaches. We describe percutaneous treatment of scalp AVM, using a new liquid embolic agent, SQUID. Because of its nonadhesive property, prolonged injection and complete obliteration of scalp AVM is feasible. The cast formed is aesthetically appealing to the patient, and it may obviate the need for further surgical excision. It could be considered as the primary treatment option for patients unwilling for surgery.

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The superior ophthalmic vein approach for the treatment of carotid-cavernous fistulas: a novel technique using Onyx

Neurosurgical FOCUS ◽

10.3171/2012.1.focus123 ◽

2012 ◽

Vol 32 (5) ◽

pp. E13 ◽

Cited By ~ 21

Author(s):

Nohra Chalouhi ◽

Aaron S. Dumont ◽

Stavropoula Tjoumakaris ◽

L. Fernando Gonzalez ◽

Jurij R. Bilyk ◽

...

Keyword(s):

Treatment Option ◽

Primary Treatment ◽

Embolic Agent ◽

Superior Ophthalmic Vein ◽

Type D ◽

Liquid Embolic ◽

Complete Obliteration ◽

Liquid Embolic Agent ◽

Carotid Cavernous Fistulas

Object Endovascular therapy is the primary treatment option for carotid-cavernous fistulas (CCFs). Operative cannulation of the superior ophthalmic vein (SOV) provides a reasonable alternative route to the cavernous sinus when all transvenous and transarterial approaches have been unsuccessful. The role of the liquid embolic agent Onyx in the management of CCFs has not been well documented, especially when using an SOV approach. The purpose of this study is to assess the safety and efficacy of Onyx embolization of CCFs through a surgical cannulation of the SOV. Methods The authors retrospectively reviewed all patients with CCFs who were treated with Onyx through an SOV approach between April 2009 and April 2011. Traditional endovascular approaches had failed in all patients. Results A total of 10 patients were identified, 1 with a Type A CCF, 5 with a Type B CCF, and 4 with a Type D CCF. All fistulas were embolized in 1 session. Onyx was the sole embolic agent used in 7 cases and was combined with coils in 3 other cases. Complete obliteration was achieved in 8 patients and a significant reduction in fistulous flow was achieved in 2 patients, which later progressed to near-complete occlusion on angiographic follow-up. All patients experienced a complete clinical recovery with excellent cosmetic results and were free from recurrence at their latest clinical follow-up evaluations. Conclusions Onyx embolization is an excellent therapy for CCFs in general, and through an SOV approach in particular. Direct operative cannulation of the SOV followed by Onyx embolization may be the best treatment option in patients with CCFs when all other endovascular approaches have been exhausted.

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Periorbital Inner Canthal Arteriovenous Malformations: Percutaneous Glue Embolization in Three Cases

Journal of Clinical Interventional Radiology ISVIR ◽

10.1055/s-0039-3401328 ◽

2020 ◽

Vol 4 (01) ◽

pp. 55-59

Author(s):

Krishnan Nagarajan ◽

Arul A. S. Babu ◽

Sekar Sabarish ◽

Swamiappan Elango ◽

Krishna Ramesh Babu ◽

...

Keyword(s):

Arteriovenous Malformations ◽

Vascular Malformations ◽

Surgical Excision ◽

High Flow ◽

Embolic Agent ◽

Cyanoacrylate Glue ◽

Liquid Embolic ◽

Liquid Embolic Agent ◽

Glue Embolization ◽

Attention To Detail

AbstractInner canthal or palpebral arteriovenous malformations (AVMs) are uncommon and difficult lesions to treat if they are of high-flow type. Though they may present with mainly cosmetic reasons, they derive feeders from the ophthalmic artery and are associated with dangerous anastomoses. Percutaneous liquid embolic agent has been used to treat various head and neck vascular malformations and tumors and, if done in meticulous attention to detail, can offer cure or control before surgical excision. We report three adults who presented with medial canthal swelling and on imaging diagnosed to have high-flow AVMs. They underwent percutaneous n-butyl cyanoacrylate (glue) embolization and subsequently operated to excise the embolized malformation without any blood loss or complications.

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Minimally Invasive Treatment of a Bronchobiliary Fistula that Developed Secondary to Chemotherapy-induced Stricturing

American Journal of Interventional Radiology ◽

10.25259/ajir-29-2018 ◽

2018 ◽

Vol 2 ◽

pp. 13

Author(s):

Samuel L Rice ◽

Patrick H Dinkelborg ◽

Leah R Flood ◽

William Alago

Keyword(s):

Minimally Invasive ◽

Biliary Tree ◽

Embolic Agent ◽

Fistula Tract ◽

Invasive Treatment ◽

Bronchobiliary Fistula ◽

Percutaneous Embolization ◽

Liquid Embolic ◽

Bronchial System ◽

Liquid Embolic Agent

A bronchobiliary fistula (BBF) is a rare abnormal communication between the biliary tree and bronchial system. The majority of cases are the result of biliary obstruction or injury, with the major symptomatology of cough and biliptysis. The initial management of BBFs is variable but aims to decompress the biliary system allowing for diversion and passive healing of the fistula tract. Definitive management is with surgical fistulectomy. New minimally invasive therapeutic approaches utilizing endoscopic or percutaneous methodology have been described with some success. We present the successful treatment of a BBF that developed secondary to chemotherapy-induced biliary stricturing (CIBS) with a novel percutaneous embolization approach using a vascular plug and liquid embolic agent.

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Embolization of spinal intramedullary arteriovenous malformations using the liquid embolic agent, Onyx: a single-center experience in a series of 17 patients

Journal of Neurosurgery Spine ◽

10.3171/spi-07/11/478 ◽

2007 ◽

Vol 7 (5) ◽

pp. 478-485 ◽

Cited By ~ 55

Author(s):

Rufus A. Corkill ◽

Aristotelis P. Mitsos ◽

Andrew J. Molyneux

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Malformations ◽

Vascular Malformations ◽

Signs And Symptoms ◽

Treatment Method ◽

Embolic Agent ◽

Functional Evaluation ◽

Liquid Embolic ◽

Liquid Embolic Agent

Object The aim of this study was to analyze the endovascular treatment results of using the Onyx liquid embolic system for spinal intramedullary arteriovenous malformations (AVMs). Methods The clinical and radiological records of 17 patients with symptomatic spinal intramedullary AVMs treated exclusively by embolization with Onyx between 1999 and 2003 were retrospectively reviewed. There were 12 females and five males in the patient series (mean age 29 years). Four of these AVMs were located in the cervical spine, eight in the thoracic spine, and five in the lumbar spine. The clinical presentation of these AVMs included upper motor neuron signs and symptoms, and hemorrhage was the initial presentation in 12 patients. Neurological and functional evaluation was performed before and after treatment with Onyx in all patients. Results Thirteen patients underwent a single endovascular treatment and four patients underwent two endovascular treatments (average 1.23 sessions per patient). Intraprocedural complications occurred on two occasions without neurological consequences. The mean follow-up duration was 24.3 months. Angiographic outcomes included total AVM obliteration in six patients (37.5%), subtotal obliteration in five patients (31.25%), and partial obliteration in five patients (31.25%). Improvement in neurological and/or functional status was noted in 14 patients, resulting in an 82% rate of overall good clinical outcome. Conclusions Embolization using the Onyx system is a promising treatment method for spinal vascular malformations, even for challenging intramedullary AVMs. Larger studies with longer follow-up durations will further enhance our knowledge on the safety and efficacy of this relatively new liquid embolic agent.

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The dual microcatheter technique for transvenous embolization of dural arteriovenous fistulae

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012713 ◽

2016 ◽

Vol 9 (6) ◽

pp. 578-582 ◽

Cited By ~ 4

Author(s):

Isaac Josh Abecassis ◽

John D Nerva ◽

Basavaraj V Ghodke ◽

Laligam N Sekhar ◽

Michael R Levitt ◽

...

Keyword(s):

Venous Drainage ◽

Embolic Agent ◽

Transvenous Embolization ◽

Arteriovenous Fistulae ◽

Liquid Embolic ◽

Complete Obliteration ◽

Liquid Embolic Agent ◽

Cerebral Venous Drainage ◽

Distal Aspect

BackgroundDural arteriovenous fistulae (dAVFs) comprise 10–15% of all intracranial arteriovenous malformations. The goal of surgical or endovascular intervention is complete obliteration of the fistulous connection(s). In cases where dAVF venous drainage is separate from normal cortical drainage, transvenous embolization can provide fast and effective fistula obliteration.ObjectiveTo describe a new method of efficient transvenous embolization (the ‘dual microcatheter technique’) for the treatment of dAVFs.MethodsThree patients with dAVFs were treated using the dual microcatheter technique for transvenous embolization. Two microcatheters were placed in the distal aspect of the dAVF venous pouch, after which coil embolization reduced fistula flow, and liquid embolic agent injection with reflux into arterial feeders completed the obliteration of the fistula.ResultsLesion grade ranged from Borden–Shucart grades 2 through 3. In all cases, dAVF venous drainage was isolated from the normal cerebral venous drainage. Dual microcatheter transvenous embolization was successful in all patients, with non-target embolization and no new postoperative deficits. At the last follow-up, all three patients were symptom-free without evidence of radiographic recurrence.ConclusionsThe dual microcatheter technique of transvenous dAVF embolization is safe and feasible in cases where dAVF venous outflow is isolated from normal cerebral venous drainage.

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Precipitating hydrophobic injectable liquid embolization of intracranial vascular shunts: initial experience and technical note

Journal of Neurosurgery ◽

10.3171/2017.6.jns16447 ◽

2018 ◽

Vol 129 (5) ◽

pp. 1217-1222 ◽

Cited By ~ 5

Author(s):

Shriram Varadharajan ◽

Arvinda Hanumanthapura Ramalingaiah ◽

Jitender Saini ◽

Arun Kumar Gupta ◽

B. Indira Devi ◽

...

Keyword(s):

Endovascular Embolization ◽

Technical Note ◽

Embolic Agent ◽

Arteriovenous Fistulas ◽

Embolic Agents ◽

Liquid Embolic ◽

Complete Obliteration ◽

Liquid Embolic Agent ◽

Pial Arteriovenous Fistula

Precipitating hydrophobic injectable liquid (PHIL) is a newly available liquid embolic agent for endovascular therapy. It is nonadhesive and composed of a biocompatible polymer dissolved in dimethyl sulfoxide solvent and bonded covalently with iodine.In this report, the authors present their preliminary experience using PHIL in the treatment of intracranial vascular shunts. Between July 2015 and December 2015, 11 patients underwent endovascular embolization using the PHIL embolic agent. Five patients had arteriovenous malformations, 4 had dural arteriovenous fistulas, 1 patient had a carotid-cavernous fistula, and 1 patient had a pial arteriovenous fistula. Clinical features, angioarchitectural characteristics, procedural details, and periprocedural complications were included in the analysis.Complete or near-complete obliteration of the nidus or fistulas was achieved in 8 of these patients. Partial embolization (approximately 80% in 2 and 30% in 1) was attained in the other 3 patients. Satisfactory venous penetration after nidal embolization was achieved in all patients. In 1 patient, the microcatheter could not be retrieved. No other major complications related to PHIL injection were noted during the procedure or periprocedural period. Clinical follow-up ranging from 8 months to 1 year showed good outcomes in all but 1 patient, who experienced an intraventricular hemorrhage 6 weeks after embolization.PHIL appears to be an effective alternative embolic material with certain advantages over other available liquid embolic agents. Further studies with adequate follow-up are required to fully evaluate its safety and efficacy.

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Use of Phil Embolic Agent for Bleeding in Non-Neurological Interventions

Journal of Clinical Medicine ◽

10.3390/jcm10040701 ◽

2021 ◽

Vol 10 (4) ◽

pp. 701

Author(s):

Pierleone Lucatelli ◽

Mario Corona ◽

Leonardo Teodoli ◽

Piergiorgio Nardis ◽

Alessandro Cannavale ◽

...

Keyword(s):

Clinical Success ◽

Embolic Agent ◽

Fluoroscopic Guidance ◽

Gastric Bleeding ◽

Percutaneous Embolization ◽

Safety And Efficacy ◽

Liquid Embolic ◽

Internal Iliac ◽

Liquid Embolic Agent ◽

Single Intervention

Objective: To evaluate the safety and efficacy of the Phil liquid embolic agent in non-neurological embolization procedures. M&M: Thirty-five patients with a mean age of 62.5 years underwent percutaneous embolization using Phil for the treatment of visceral arterial bleedings in 20/35 patients (including three gluteal, one bladder, two superior mesenteric, three epigastric, one deep femoral, five internal iliac, four intercostal, and one lingual arteries), splanchnic pseudoaneurysms in 11/35 patients (including three hepatic, five splenic, and three renal arteries), pancreatic bleeding metastasis in 1/35 patient, and gastric bleeding varices in 3/35 patients. Phil is composed of a non-adhesive copolymer dissolved in DMSO (Anhydrous Dimethyl Sulfoxide) with different viscosity. Procedures were performed slowly under continuous fluoroscopic guidance to avoid embolization of non-target vessels. Results: Clinical success was obtained with a single intervention in 34 cases (97.15%), while a repeated procedure was required in one case (2.85%). No technical complications nor non-target embolization occurred. A case of post-embolic syndrome was noted (2.85%) in one patient. DMSO administration-related pain was successfully controlled by medical therapy. Conclusion: Phil can be considered a safe and effective embolic agent for the treatment of non-neurologic bleeding.

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