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J Clin Imaging Sci. 2018 Nov 15;8:46. doi: 10.4103/jcis.JCIS_64_18. eCollection 2018.

Upper Gastrointestinal Bleed Embolization with Onyx®: The "Tattoo Effect".

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Division of Vascular and Interventional Radiology, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
Division of Gastroenterology and Hepatology, University of Kentucky, College of Medicine, Lexington, Kentucky, USA.


Endoscopic intervention is well validated for the control of upper gastrointestinal bleeding (UGIB). In cases of refractory bleeding, transarterial embolization is a safe and effective alternative. Ethylene vinyl alcohol (EVOH) commonly known as Onyx® is an inherently black liquid embolic approved for use in cerebrovascular arteriovenous malformations and is increasingly used as an embolic agent in multiple peripheral and visceral territories. Onyx® has a uniquely undesirable property of causing black color discoloration when used in peripheral applications adjacent to the skin akin to a "tattoo effect." Knowledge of the agents used by the interventional radiologist, clinical correlation, and close follow-up can be of paramount importance to avoid unnecessary surgical intervention. Here, we report a case demonstrating this "tattoo effect" on the gastric mucosa following UGIB embolization.


Embolization; Onyx; ethylene vinyl alcohol; right gastric artery; tattoo; upper gastrointestinal bleeding

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