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Congress: ECR25
Poster Number: C-25739
Type: Poster: EPOS Radiologist (scientific)
Authorblock: E. Massaro, M. A. Tipaldi, S. Vagnarelli, M. Rossi; Roma/IT
Disclosures:
Edoardo Massaro: Nothing to disclose
Marcello Andrea Tipaldi: Nothing to disclose
Simone Vagnarelli: Nothing to disclose
Michele Rossi: Nothing to disclose
Keywords: Vascular, Catheter arteriography, Embolisation, Haemorrhage
Conclusion

This series showed that transarterial embolization with Onyx is a safe and effective treatment for patients with intractable external carotid hemorrhage.   Onyx, compared to other embolizing agents, has already shown some undeniable advantages.Summing up, Onyx is more governable and controllable than other embolizing agents.8

In addition, unlike PVA and Coils, the efficacy of Onyx does not depend on the coagulation status: mechanisms of action of both coils and PVA are based on their thrombogenic activity, an aspect that can be a limitation in patients with coagulopathy. 

Onyx fully adheres to the vessel, keeping it occluded even in the recovery of the real diameter.9, 10 Even the risk of blockage or "stuck" of the infusion catheter is lower with Onyx.11

Lastly, it is good to remember that Onyx, as a permanent embolizing agent, reduces the risk of re-bleeding when compared to temporary embolizing agents, such as Spongostan.12

Obviously, Onyx has some disadvantages like the cost, higher than other embolizing agents, and the slow learning curve, especially for minimizing the risk of non-target embolization.13, 14, 15

One of disadvantages commonly attributed to the Onyx is the “activation time”: it is important to emphasize that necessary time to prepare the patient for the embolization procedure (anesthesia, finding arterial access, preoperative angiography, positioning the microcatheter) coincides briefly with the time required to prepare the embolizing agent. Additionally, is being studied currently an embolizing agent, which is similar to Onyx but does not require any activation and is therefore ready for use: this new embolizing liquid agent is called PHIL or "Precipitating Hydrophobic Injectable Liquid" (Microvention Inc. Tustin, CA, USA) and is showing promising results in in vitro and in vivo studies.16, 17, 18, 19

Onyx's disadvantages are also minor reactions that follow its infusion: the most commonly reported side effects is the burning sensation resulting from the exothermic reaction that is generated from the contact between Onyx and blood, especially when it is injected rapidly; this is a minor issue but it should not be underestimated, because is an indication of temporary interruption of the embolization procedure.20.

 
GALLERY