Transcatheter Embolization with Squid, Combined with Other Embolic Agents or Alone, in Different Abdominal Diseases: a Single-center Experience in 30 Patients

Overview

Journal CVIR Endovasc

Date 2020 Feb 7

PMID 32026992

Citations 22

Authors

Massimo Venturini

Carolina Lanza

Paolo Marra

Anna Colarieti

Marta Panzeri

Luigi Augello

Simone Gusmini

Marco Salvioni

Francesco De Cobelli

Alessandro Del Maschio

Affiliations

Soon will be listed here.

Abstract

Background: Squid, as Onyx, is an ethylene-vinyl alcohol copolymer (EVOH)-based liquid embolic agent developed for neuroradiologic interventions with poor application in abdominal district. Our aim was to evaluate safety, complications, and efficacy of transcatheter embolization using the two available formulations Squid-18 and 12, in 30 patients affected by different abdominal diseases.

Results: Transcatheter embolization with Squid, combined with other embolic agents, as poly vinyl alcohol (PVA) particles, coils and amplatzer plugs, or alone (type 2 endoleak), was performed in 30 patients, as follows: 10 portal vein embolizations (PVEs), 6 arteriovenous malformations (AVMs), 5 visceral artery aneurysms (VAAs), 4 type 2 endoleaks, 3 preoperative embolizations, 1 acute arterial bleeding, 1 female varicocele. Squid was always administered using dimethyl sulfoxide (DMSO) compatible microcatheters. Technical success, 30-day clinical success and complications were assessed. Technical success was 90%. 3 patients (2 AVMs, 1 VAA) required re-intervention successfully performed in all cases. Major complications, cases of microcatheter entrapment and DMSO-related poor pain control were not recorded. 30-day clinical success was 93.3%: in 2 patients submitted to PVE a sufficient future liver remnant (FLR) hypertrophy was not achieved.

Conclusion: Squid was successfully used with low complication rate in many abdominal diseases showing a valid embolic action either combined with other embolic agents or alone in type 2 endoleak. The availability of different formulations (Squid-18 and Squid-12) variable for viscosity makes Squid preferable to Onyx as EVOH-based liquid embolic agent, even though comparable studies in different abdominal districts with a larger cohort of patients will be necessary.

Citing Articles

The Advantages of Non-Adhesive Gel-like Embolic Materials in the Endovascular Treatment of Benign Hypervascularized Lesions of the Head and Neck.

Petrov A, Ivanov A, Kolomin E, Tukanov N, Petrova A, Rozhchenko L Gels. 2023; 9(12).

PMID: 38131940 PMC: 10742558. DOI: 10.3390/gels9120954.

Peripheral Arteriovenous Malformation Embolization Using Squid.

Ahmad S, Uddin M Case Rep Vasc Med. 2023; 2023:8858656.

PMID: 37808585 PMC: 10560117. DOI: 10.1155/2023/8858656.

Translumbar type II endoleak embolization with a new liquid iodinated polyvinyl alcohol polymer: Case series and review of current literature.

Leati G, Di Bartolomeo F, Maffi G, Boccalon L, Diaco D, Segalini E Front Radiol. 2023; 3:1145164.

PMID: 37492376 PMC: 10365270. DOI: 10.3389/fradi.2023.1145164.

Pulmonary Artery Pseudoaneurysms Embolization: Bicentric Experience and Review of the Literature.

Fontana F, Piacentino F, Curti M, Ierardi A, Coppola A, Macchi E J Clin Med. 2023; 12(11).

PMID: 37297991 PMC: 10253550. DOI: 10.3390/jcm12113796.

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

Rolland R, Loubet A, Bommart S, Monnin-Bares V, Zarqane H, Vanoverschelde J J Clin Med. 2023; 12(10).

PMID: 37240490 PMC: 10218790. DOI: 10.3390/jcm12103385.

References

Yoon D, Jones M, Al Taani J, Buhimschi C, Dowell J . A Systematic Review of Acquired Uterine Arteriovenous Malformations: Pathophysiology, Diagnosis, and Transcatheter Treatment. AJP Rep. 2016; 6(1):e6-e14. PMC: 4737639. DOI: 10.1055/s-0035-1563721. View

Khaja M, Park A, Swee W, Evans A, Angle J, Turba U . Treatment of type II endoleak using Onyx with long-term imaging follow-up. Cardiovasc Intervent Radiol. 2013; 37(3):613-22. DOI: 10.1007/s00270-013-0706-z. View

Gioppo A, Farago G, Caldiera V, Caputi L, Cusin A, Ciceri E . Medial Tentorial Dural Arteriovenous Fistula Embolization: Single Experience with Embolic Liquid Polymer SQUID and Review of the Literature. World Neurosurg. 2017; 107:1050.e1-1050.e7. DOI: 10.1016/j.wneu.2017.08.050. View

Venturini M, Marra P, Colombo M, Alparone M, Agostini G, Bertoglio L . Endovascular Treatment of Visceral Artery Aneurysms and Pseudoaneurysms in 100 Patients: Covered Stenting vs Transcatheter Embolization. J Endovasc Ther. 2017; 24(5):709-717. DOI: 10.1177/1526602817717715. View

Kim P, Tsauo J, Shin J, Yun S . Transcatheter Arterial Embolization of Gastrointestinal Bleeding with N-Butyl Cyanoacrylate: A Systematic Review and Meta-Analysis of Safety and Efficacy. J Vasc Interv Radiol. 2017; 28(4):522-531.e5. DOI: 10.1016/j.jvir.2016.12.1220. View

Gemmete J, Ansari S, Gandhi D . Endovascular techniques for treatment of carotid-cavernous fistula. J Neuroophthalmol. 2009; 29(1):62-71. DOI: 10.1097/WNO.0b013e3181989fc0. View

Alturki A, Enriquez-Marulanda A, Schmalz P, Ogilvy C, Thomas A . Transarterial Onyx Embolization of Bilateral Transverse-Sigmoid Dural Arteriovenous Malformation with Transvenous Balloon Assist-Initial U.S. Experience with Copernic RC Venous Remodeling Balloon. World Neurosurg. 2017; 109:398-402. DOI: 10.1016/j.wneu.2017.10.083. View

Bailey M, McPherson S, Troxler M, Peach A, Patel J, Scott D . Ischemic skin ulceration complicating glue embolization of type II endoleak after endovascular aneurysm repair. J Vasc Interv Radiol. 2011; 22(2):163-7. DOI: 10.1016/j.jvir.2010.10.018. View

Szatmary Z, Hillman J, Finitsis S . Meningioma embolization with the pressure cooker technique using Squid 12. Interv Neuroradiol. 2017; 23(4):441-443. PMC: 5684910. DOI: 10.1177/1591019917707328. View

10.

Olthof P, Coelen R, Bennink R, Heger M, Lam M, Besselink M . Tc-mebrofenin hepatobiliary scintigraphy predicts liver failure following major liver resection for perihilar cholangiocarcinoma. HPB (Oxford). 2017; 19(10):850-858. DOI: 10.1016/j.hpb.2017.05.007. View

11.

Sheth R, Sabir S, Krishnamurthy S, Avery R, Zhang Y, Khademhosseini A . Endovascular Embolization by Transcatheter Delivery of Particles: Past, Present, and Future. J Funct Biomater. 2017; 8(2). PMC: 5491993. DOI: 10.3390/jfb8020012. View

12.

van Lienden K, van den Esschert J, De Graaf W, Bipat S, Lameris J, van Gulik T . Portal vein embolization before liver resection: a systematic review. Cardiovasc Intervent Radiol. 2012; 36(1):25-34. PMC: 3549243. DOI: 10.1007/s00270-012-0440-y. View

13.

Ikeda O, Nakasone Y, Tamura Y, Yamashita Y . Endovascular management of visceral artery pseudoaneurysms: transcatheter coil embolization using the isolation technique. Cardiovasc Intervent Radiol. 2010; 33(6):1128-34. DOI: 10.1007/s00270-010-9973-0. View

14.

Singfer U, Hemelsoet D, Vanlangenhove P, Martens F, Verbeke L, Van Roost D . Unruptured Brain Arteriovenous Malformations: Primary ONYX Embolization in ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)-Eligible Patients. Stroke. 2017; 48(12):3393-3396. DOI: 10.1161/STROKEAHA.117.018605. View

15.

Angle J, Siddiqi N, Wallace M, Kundu S, Stokes L, Wojak J . Quality improvement guidelines for percutaneous transcatheter embolization: Society of Interventional Radiology Standards of Practice Committee. J Vasc Interv Radiol. 2010; 21(10):1479-86. DOI: 10.1016/j.jvir.2010.06.014. View

16.

Brassel F, Meila D . Evolution of Embolic Agents in Interventional Neuroradiology. Clin Neuroradiol. 2015; 25 Suppl 2:333-9. DOI: 10.1007/s00062-015-0419-6. View

17.

Lv X, Song C, He H, Jiang C, Li Y . Transvenous retrograde AVM embolization: Indications, techniques, complications and outcomes. Interv Neuroradiol. 2017; 23(5):504-509. PMC: 5624411. DOI: 10.1177/1591019917716817. View

18.

Akmangit I, Daglioglu E, Kaya T, Alagoz F, Sahinoglu M, Peker A . Preliminary experience with squid: a new liquid embolizing agent for AVM, AV fistulas and tumors. Turk Neurosurg. 2014; 24(4):565-70. DOI: 10.5137/1019-5149.JTN.11179-14.0. View

19.

Laborda A, Medrano J, de Blas I, Urtiaga I, Carnevale F, De Gregorio M . Endovascular treatment of pelvic congestion syndrome: visual analog scale (VAS) long-term follow-up clinical evaluation in 202 patients. Cardiovasc Intervent Radiol. 2013; 36(4):1006-14. DOI: 10.1007/s00270-013-0586-2. View

20.

Chevallier O, Gehin S, Foahom-Kamwa A, Pottecher P, Favelier S, Loffroy R . Ethylene-vinyl alcohol copolymer (Onyx(®)) transarterial embolization for post-traumatic high-flow priapism. Quant Imaging Med Surg. 2016; 6(3):323-7. PMC: 4929282. DOI: 10.21037/qims.2016.06.02. View