SIR 2024
Nonvascular Interventions
Rohit Anand, MD
Diagnostic Radiology Resident Physician
Loyola University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
Joseph Kus, MD (he/him/his)
Diagnostic Radiology Resident Physician
Loyola University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
John Olivieri, Jr., MD (he/him/his)
Diagnostic Radiology Resident Physician
Loyola University Medical Center
Financial relationships: Full list of relationships is listed on the CME information page.
John Annes, MD
Interventional Radiologist
Loyola University Medical Center
Disclosure information not submitted.
Angelo Malamis, MD
Interventional Radiologist
Loyola University Medical Center
Disclosure information not submitted.
Christopher Molvar, MD
Interventional Radiologist
Loyola University Medical Center
Disclosure information not submitted.
Marc Borge, MD
Medical Director of Interventional Radiology
Loyola University Medical Center
Disclosure information not submitted.
1) State the indications for ureteral embolization and provide an overview of ureteral embolization technique. 2) Illustrate the utility of Ethylene Vinyl Alcohol Copolymer (Onyx) and MVP microvascular plugs for ureteral embolization by showcasing a case series of patients. 3) Demonstrate imaging features following ureteral embolization. 4) Provide an updated literature review comparing various embolic materials for ureteral occlusion. 5 consecutive patients (mean age 72.2, 40% female) underwent ureteral embolization with Onyx and MVP microvascular plugs. A total of 9 ureters were occluded.
Background: Ureteral embolization is a minimally invasive method for the management of patients with persistent urinary leakage secondary to complex ureteral fistulae and due to bladder pathology. Traditional embolic agents include coils, detachable balloons, gelfoam, glue, and vascular plugs.The goal of ureteral embolization is to safely, quickly, and durably occlude the ureter without migration of embolic material and without recanalization.
Ethylene vinyl alcohol copolymer (Onyx) is a non-adhesive liquid embolic agent that has been primarily utilized for the treatment of intracranial and extracranial arteriovenous malformations. Ureteral embolization with Onyx in combination with Amplatzer II Plugs has been described {1}. This exhibit describes a single-institution experience of ureteral embolization utilizing Onyx in combination with MVP microvascular plugs for patients with persistent urinary leakage.
Clinical Findings/Procedure Details:
In each case, external urinary diversion had been obtained via percutaneous nephrostomy tube placement. Utilizing a guidewire, the nephrostomy tube was exchanged for a vascular sheath, which was advanced into the distal segment of the ureter. An MVP microvascular plug was then deployed into the distal segment of the ureter, followed by administration of Onyx. An additional microvascular plug was then deployed. Microvascular plug size was per operator preference. Post-embolization nephrostogram was performed to confirm occlusion.
Technical success was achieved in 100% of cases. No immediate complications were recorded. One patient had persistent urinary leakage following the procedure, requiring re-embolization. The treated ureters remained occluded for a mean follow up time of 676 days.
Conclusion and/or Teaching Points: Ureteral embolization utilizing a combination of Onyx and MVP microvascular plugs offers safe, effective, and durable ureteral occlusion. This technique warrants investigation with further clinical studies.