Ethyl Vinyl Alcohol co-polymer Onyx (ev3 Inc., Irvine, CA) is a non-adhesive but cohesive liquid embolic agent that can be used to occlude vascular lesions. On label indications are for arteriovenous malformations, but the fluid has been useful in a variety of clinical scenarios including dural arteriovenous fistulae (dAVF), aneurysms, tumour embolisation and others. The key drawbacks of these techniques are in the time, material, and radiation needed for the formation of a proximal plug to force the flow of Onyx forward into the vascular territory, as well as the possibility of difficult catheter removal. The usage of Oynx in conjunction with the Scepter C dual lumen coaxial balloon system (MicroVention, Tustin, CA) can circumvent the need for plug formation and avoid associated drawbacks.Materials and Methods
The endovascular database at a single institution was reviewed to assess for cases in which ethyl vinyl alcohol was used in conjunction with a Scepter C balloon. In each case, the Scepter C balloon was navigated to the target artery under fluoroscopic roadmap assistance. The balloon was inflated to occlude the vessel, and the lumen was flushed with DMSO. Onyx 18 embolisation was subsequently performed under continuous fluoroscopy until stasis was observed. The cases are reviewed and summarised with attention to fluoroscopy time between the initiation of ethyl vinyl alcohol embolisation and the cessation of ethyl vinyl alcohol embolisation.Results
Five consecutive patients were treated with a combination of ethyl vinyl alcohol and the Scepter C balloon. In the three tumour cases, a total of six pedicles were embolised; in the dural fistulae cases, two pedicles were embolised. No immediate per-procedural complications occurred. Total fluoroscopy time, average fluoroscopy time per injection, and total time between initial injection and cessation of embolisation are accessed and compared to historical data on Onyx-only embolisation procedures. In a single case, reflux occurred secondary to a loose valve that led to an unplanned balloon deflation.Conclusion
The Scepter C balloon may be used off-label to deliver ethyl vinyl alcohol for the treatment of dAVF and tumour embolisation. Diminished fluoroscopy times and embolysate injection times may be achieved using an in-line balloon that results in an immediate block to retrograde flow, obviating the need to form a proximal “plug”. Further research is necessary to confirm safety and radiation exposure benefits, especially in arteriovenous malformations.Disclosures
C. Chung: None. T. Osanai: None. F. Hui: 3; C; MicroVention, Penumbra.