Introduction and purpose Surgical resection of hypervascular paraganglioma can be difficult due to intraoperative blood loss. Preoperative endovascular embolization with particulate material facilitates safe and complete surgical resection. However, complete devascularization is often impossible due to an inability to selectively catherize tiny feeding arteries or short pedicles arising from the carotid bifurcation with concerns for embolic reflux. We present our initial angiographic and clinical outcomes using only Onyx (ethylene vinyl alcohol) for percutaneous embolization of paragangliomas at the carotid bifurcation.
Materials and methods A consecutive series of five patients with five paragangliomas (carotid body tumors) located at the carotid bifurcation were treated solely with percutaneous Onyx embolization. Fluoroscopic roadmap and ultrasound guided access was utilized for percutaneous needle placement. Onyx 18 and Onyx 34 were infused under constant negative roadmap fluoroscopy. Onyx embolization was continued until devascularization was achieved by angiography or reflux occurred into the feeding arterial pedicles or draining veins.
Results Complete devascularization of the five paragangliomas was achieved using a percutaneous embolization technique with Onyx as the sole agent without complications. An average of 2.5 needles (range 2–4) were placed into each carotid body tumor under fluoroscopic and ultrasound guidance. An average of 6.9 ml (range 5–8.5 ml) of Onyx was injected in each tumor. Complete devascularization was achieved in each case by angiography. Surgical resection was subjectively reported to be less intensive with a decreased need for cauterization and reduced intraoperative blood loss. Intraoperative blood loss averaged 80 ml (range 10–200 ml).
Conclusion Our preliminary experience suggests that percutaneous Onyx embolization may offer a higher degree of devascularization compared with other embolic agents, allowing safe and complete surgical resection as well as reducing intraoperative blood loss. Onyx appears to be a safe embolic agent when injected percutaneously due to its inherent cohesive nature allowing controlled extended injections, ability to intermittently pause and redirect its flow into the tumor vascular bed.
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Competing interests None.
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