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