Ethylene Vinyl Alcohol Copolymer (Onyx) Embolization for Acute Hemorrhage: A Systematic Review of Peripheral Applications

Purpose To evaluate the endovascular use of ethylene vinyl alcohol (EVOH) copolymer (Onyx; ev3 Endovascular, Inc, Plymouth, Minnesota) for the treatment of acute peripheral nonneurologic hemorrhage. Materials and Methods MEDLINE and PubMed databases were searched for articles published in English from 1946 to August 2014 describing patients treated for hemorrhage with EVOH copolymer outside of its usual neurovascular applications. Additional cases were collected from the bibliographies of relevant articles. Full-text articles were obtained. Demographic data, clinical presentation, underlying etiology, culprit vessel, endovascular treatment, outcomes, and follow-up times were obtained. Results The literature search yielded 19 relevant articles. Cases of 131 patients (87 men, 44 women; mean age, 61 y ± 19.2) describing the treatment of 151 lesions were reviewed. The most common categories of arterial lesions were gastrointestinal (n = 53) and bronchial (n = 40) in origin. In 14 cases, EVOH copolymer was employed after failure or rebleeding following the use of a different embolic agent. Average follow-up time was 12.0 months. EVOH copolymer was the sole embolic agent used in 105 patients. Rebleeding after treatment with EVOH copolymer occurred in 10 patients. There were 2 technical failures. One patient died of multiorgan failure in the setting of persistent hemoptysis. Complications included 2 nerve injuries and 2 minor strokes. Conclusions Embolization of acute hemorrhage in the peripheral vasculature was safe and effective with EVOH copolymer.