Easy Retrieval of Escaping Onyx Fragment with Percutaneous Manual Aspiration

Excerpt

The ability of embolization of arteriovenous malformations (AVMs) has increased with the use of Onyx liquid embolic material [1]. The application of the ethylene–vinyl alcohol copolymer (EVOH) in the endovascular treatment of intracranial AVMs was first described by Taki et al. and Terada et al. in the early 1990s [2, 3]. Onyx is an elastic polymer with a lavalike flow pattern that may be used within blood vessels and does not fragment during injection. Onyx is not absorbable and is capable of producing permanent vascular occlusion [4, 5]. Onyx can be used to embolize not only the intracranial AVMs but also the peripheral pseudoaneurysms and malformations [6]. A set of clinical complications that are related to the use of Onyx were described, including reflux of Onyx into the afferent artery peduncle, subarachnoid hemorrhage, and cerebral and pulmonary edema in part as a result of the dimethyl sulfoxide (DMSO) solvent used in Onyx [7, 8]. Extension of Onyx to the parent vessel is a rare complication that has been reported during treatment of AVMs. It has been shown that the Onyx substance can be retrieved with dedicated mechanical retrieval devices [9]. …