19. May 2021
Our publication Safety and Efficacy of Peripheral Embolization with EASYX Liquid Embolic Agent: A multicenter Prospective Study was accepted by the Journal of Vascular Interventional Radiology.
The EASYX I clinical trial results reveals a clear statement the PVA generation of Liquid Embolic Agents (LEA)are safe and efficient and do have advantages against all other LEAs
The use of cyanoacrylates, used for embolization for a long period of time, has decreased in the last decades, they are currently still used not anymore for their embolic properties but due to their low-price advantage: in most countries, cyanoacrylates are much cheaper than Onyx, Squid, PHIL or EASYX.
Well-known drawbacks of the EVOH (Ethylene vinyl alcohol) based generation LEAs (liquid embolic agencies) in particular Onyx and Squid are
- the frequent and heavy imaging artifacts which occur predominantly in CT imaging due to their Tantalum content
- the degree of toxicity and the inflammatory effects on the embolized vessels leads to a painful therapy which inevitably requires the use of perioperative administration of anti-inflammatory drugs, such as corticosteroids and adequate sedation is needed
- the fact that they appear black due to the admixed tantalum powder, can lead to macroscopically visible black colorization of superficially embolized blood vessels
Available clinical studies on the following HEMA (Hydroxyethyl methacrylate) based LEAs per example PHIL reported less artifacts compared to Onyx and Squid this thanks to the absence of tantalum.
Unfortunately, here the drawbacks are:
- the radiopacity in the HEMO based LEAs are created by a nonstable ester linkage to graft iodine with the negative effect that the radiopacity disappears after some time. So, on the one hand, the visibility improves perioperatively, but on the other hand, the visibility disappears postoperatively due to the degradable radiopacity, which is a major problem in redo cases or postoperative bleeding.
- Vasotoxic and inflammatory effects on the embolized vessels are still a topic but less than compared to EVOH based products (ONYXS and SQUID) – the toxic effects are mainly caused by the admixed high concentration of DMSO what leads to painful administration of the embolic liquid which requires perioperative administration of analgesic medication.
The use the Polyvinyl alcohol (PVA) copolymer LEA based generation “EASYX” with a High biostability, non-degradable radiopacity, lower volume and concentration of the used DMSO and no metal substances (Tantalum) gives:
- particularly no CT/MRI-artifacts anymore – clear visibility
- significant improvements on the detection of peri or postprocedural hemorrhages compared to the HEMA based product (P.Ex. Phil)
- the toxic effects are reduced to a minimum mainly because of the less injected and lower concentration DMSO used as with Phil and a statistical reduced toxicity as the EVOH based products. This benefits the patient as no analgesic or pain reduction medication is needed anymore
- It has been demonstrated that EASYX ® precipitates with a 1.3 times greater surface volume per mL of liquid embolic injection than as the HEMO based and even more up to1.5 times in comparison EVOH based products
- an optimal homogenous plug formation within max 3 minutes injection results in a reduced fluoroscopy time equal to less radiation time for the patient.
- a further advantage of EASYX is that it does not need any kind of preparation before its use. In an emergency, EASYX can be immediately used for the embolization. And the syringes can be refilled as much as is necessary for the treatment