Onyx Migration Into the Anterior Spinal Artery During Lumbar Artery Embolisation: an Adverse Event. (2018)

• Record Type: Journal Article
• Authors: Gaudry, M.; Lagier, D.; Brige, P.; Frandon, J.; Rolland, P.H.; Barral, P.A.; Piquet, P.; Vidal, V.
• Is Part Of: EJVES short reports. Volume 39(2018)
• Page Start: 20
• Page End: 23
• Publication Date: 2018
• Subjects: Embolisation -- Ischaemia -- Migration -- Onyx -- Spinal cord; Endoscopic surgery -- Periodicals; Blood-vessels -- Surgery -- Periodicals; 617.413005
• DOI: 10.1016/j.ejvssr.2018.04.001
• Languages: English
• ISSNs: 2405-6553

Abstract

Abstract : Introduction: The impact of sequential lumbar and intercostal artery occlusion on the risk of spinal cord ischaemia was evaluated; however, an adverse event (paraplegia) was encountered, which resulted in study interruption. Investigations were carried out to understand the reasons for the paraplegia. Report: To develop a porcine model of spinal cord ischaemic preconditioning prior to extensive thoraco-abdominal aneurysm endovascular aortic repair, the lumbar arteries were selectively embolised with Onyx 5 days prior to an extended thoracic aortic stent graft. Six pigs were used in this preliminary work. Four cases of paraplegia secondary to accidental migration of Onyx to the anterior spinal artery from the lumbar arteries are reported. Histological analysis confirmed severe spinal ischaemic injury and the presence of Onyx particles in the anterior spinal artery. Discussion: Onyx is used for lumbar artery embolisation in type II endoleak treatment after endovascular aortic repair, and while migration in lumbar arteries is frequent, the risk of spinal cord ischaemia has never been described. The current study demonstrates the risk of paraplegia following Onyx migration to the anterior spinal artery from the lumbar artery in an experimental model. Thus, Onyx treatment for type II endoleaks from lumbar arteries should be used cautiously. Highlights: Accidental Onyx migration to anterior spinal artery from lumbar artery is described. Onyx migration in the anterior spinal artery leads to paraplegia. The risk of spinal cord ischaemia after onyx migration has never been described. Onyx is used for lumbar artery embolisation in type II endoleak treatment. Onyx treatment for type II endoleaks from lumbar arteries should be used cautiously.