Embolization of Onyx Causing Acute Limb Ischemia

Area of Science:

• Interventional Radiology
• Vascular Surgery
• Endovascular Therapy

Background:

• Type II endoleaks are a common complication following endovascular aneurysm repair (EVAR).
• Refractory endoleaks often require complex endovascular or open surgical interventions.
• Translumbar embolization is an alternative approach for managing challenging endoleaks.

Observation:

• A patient with a refractory type II endoleak underwent translumbar embolization using Onyx.
• During the procedure, Onyx material inadvertently migrated into the endograft.
• The embolization agent subsequently extended into the infrainguinal vasculature.

Findings:

• This case describes a novel complication of translumbar Onyx embolization: intra-endograft Onyx passage.
• The embolization material spread distally, leading to unexpected vascular occlusion in the infrainguinal arteries.
• This represents a previously unreported adverse event associated with this technique.

Implications:

• This finding highlights the potential risks of translumbar Onyx embolization, particularly concerning material migration.
• Careful technique and imaging are crucial to prevent Onyx extravasation into the endograft and distal vessels.
• Further investigation is warranted to understand the mechanisms and long-term consequences of this complication.