Objective: Presentation of Onyx outcomes in the embolization of extracranial vascular malformations, regarding the clinical efficacy and safety.
Material and methods: A 29 years old female patient, with a vascular malformation of the right upper thigh complicated with skin ulcer, healed in 2011, referred for light pain and tension at the site of the lesion. Physical examination revealed a scar of a previous ulcer, extensive venous collateral network and tenuous expandability of the malformation. Angiography revealed a high flow vascular malformation, with arterial and venous component, through branches of the internal iliac, common and profunda femoral arteries, involving the right thigh, from the root to the middle third, on the lateral side. Patient was proposed for arterial catheterization and endovascular embolization, which consisted in five embolization sessions with an interval of 3 weeks, through contralateral femoral catheterization, firstly with coils; in the remaining, it was decided to embolize with Onyx, through distal catheterization of the sinus with microcatheter.
Results: All sessions coursed without major complications, registering pain complains on the first post-procedure day which reversed with anti-inflammatory medication. There was no skin necrosis or significant elevation of tissue necrosis markers. Distal embolization of malformation sinus with Onyx was achieved in all sessions without significant reflux or recurrence of the embolized branch, with decreased of the sinus size, no pain complaints and the lack of expandability after the 5 sessions.
Conclusion: Used primarily in intracranial vascular malformations, there is now a growing utilization of Onyx in the embolization of extracranial malformations, given the physical properties, with promising initial results, particularly in high-flow injuries. A recent study demonstrated a significant reduction of the malformation sinus, low rate of recanalization and re-expansion, with high clinical safety. The clinical result of this patient demonstrated the high efficacy and safety in the use of embolic agent, making its use promising in the treatment of a wide range of vascular malformations.