Successful embolization of a enterocutaneous fistula tract with Onyx 34 following low anterior resection for rectal cancer.

Enterocutaneous fistulas (ECFs) can be one of the complications found after surgical intervention for rectal cancer. Interventional modalities consisting of surgical, endoscopic, and radiological methods are often implemented to treat postoperative symptomatic complications. We present the case of 61-year-old Caucasian man who presented to us with a recent diagnosis of rectal cancer that had invaded the levators as well as anteriorly into the prostate, and who underwent low anterior resection with a diverting loop ileostomy. The patient was found to have a persistent presacral abscess due to an ECF tract. This case highlights the off-label use of ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide (Onyx 34) to seal an ECF

Onyx Use in Extracranial Pathologies - A Retrospective Case Review

Purpose: Onyx is an embolic agent currently FDA approved for neurointerventional procedures such as in the treatment of aneurysms and arteriovenous malformations. Despite its limited indications, the agent\u27s off-label use in the treatment of extracranial pathologies continues to increase. To date, there has not been a single-center study demonstrating a large number of cases demonstrating safe and effective peripheral embolization with Onyx. Materials: We performed a retrospective review of all cases that used Onyx between October 2010 and July 2016 at a single tertiary care academic university urban hospital. Institutional review board approval was appropriately obtained. Initial case selection was based on all of the procedures using Onyx. In our study, Onyx was used with the primary intention of providing definitive treatment; as a temporizing measure for future surgical resection; or for palliative symptomatic relief. Case selection was further scrutinized to exclude all cases involving the head, neck, or central nervous system. Results: 49 patients were identified who underwent embolization with Onyx for extracranial pathologies. A total of 64 instances met our criteria. The incongruent number of cases compared to patients was secondary to multiple sessions for some patients. Such cases included: venous malformation, arteriovenous malformations, type 2 endoleaks, bronchobiliary fistula, and transgluteal rectal fistula. Technical success was achieved in 100% of cases. The clinical success rate was (98%). Among all 64 cases, only one complication had occurred with nontarget embolization of a renal pseudoaneurysm status post nephrectomy. Conclusions: This study demonstrates the effectiveness of Onyx as an embolic agent that can be safely used beyond its limited FDA indication. Given the embolic agent\u27s success in neurovascular pathologies, we were able to show a wide breadth and variety of extracranial uses. Abstract Categories: Arterial Interventions: Embolizatio

Fluoroscopically guided sharp recanalization with dilation and stenting of an esophageal occlusion.

Esophageal strictures may lead to dysphagia, intolerance of normal secretions, and malnutrition. The gold standard of treatment is esophageal dilation. Though most cases are relieved by balloon dilation, one third of cases require multiple dilations. To complicate treatment further, complete occlusion of the esophagus or severe fibrotic strictures may limit the use of balloon dilation or stents. In our case, a patient with a complex fibrotic occlusion above a previously placed esophageal stent was successfully treated with a sharp recanalization technique using fluoroscopy alone

A Case Report of an Endovascular Technique for Uterine Arteriovenous Malformations

Purpose: The purpose of this case study is to illustrate an interventional radiologic technique that can be used to temporarily reduce blood flow in a rare case of a large uterine arteriovenous malformations requiring hysterectomy. Case report: A 36 year-old female with a history of two second-trimester spontaneous abortions presented for a pre-op appointment for planned hysterectomy after a pelvic MRI showed significant uterine AVM. Due to concern for hemorrhage during the surgery, bilateral iliac and bilateral ovarian arterial balloon catheters were placed under fluoroscopic guidance prior to surgery. After placement of balloon catheters under conscious sedation, the patient was transferred to the operating room. The patient was induced under general anesthesia. On diagnostic hysteroscopy, the patient had intrauterine scarring consistent with prior dilations and curettages. Balloons were inflated during surgical removal of the uterus and fallopian tubes. After hysterectomy and salpingectomies, the intra-arterial balloon catheters were deflated. The patient was hemodynamically stable and catheters were removed. She was discharged after a few days. Conclusion: As this clinical case illustrates, percutaneous minimally invasive image-guided interventional techniques may be used in complex OB/GYN patients. It is important to recognize the importance of the multidisciplinary approach to the treatment of such patients

Endovascular management of a splenic artery aneurysm

Splenic artery aneurysms represent the third most common aneurysm in the abdomen. The majority are asymptomatic and discovered incidentally by abdominal imaging. The overall rupture rate is low but the associated mortality rate is high, especially in pregnant women and patients with portal hypertension. Traditionally, open surgical modalities represented the only viable treatments. More recently, laparoscopic and endovascular techniques have been applied to these vascular lesions. We report a case of a giant splenic artery aneurysm that was diagnosed incidentally and managed successfully by percutaneous splenic artery embolization. The case is presented and general considerations regarding the presentation, diagnosis, and management of splenic artery aneurysms are reviewed. © 2007 Lippincott Williams & Wilkins, Inc

Successful embolization of a enterocutaneous fistula tract with Onyx 34 following low anterior resection for rectal cancer

© 2018 Enterocutaneous fistulas (ECFs) can be one of the complications found after surgical intervention for rectal cancer. Interventional modalities consisting of surgical, endoscopic, and radiological methods are often implemented to treat postoperative symptomatic complications. We present the case of 61-year-old Caucasian man who presented to us with a recent diagnosis of rectal cancer that had invaded the levators as well as anteriorly into the prostate, and who underwent low anterior resection with a diverting loop ileostomy. The patient was found to have a persistent presacral abscess due to an ECF tract. This case highlights the off-label use of ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide (Onyx 34) to seal an ECF