{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T04:09:21Z","timestamp":1779250161463,"version":"3.51.4"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["CVIR Endovasc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Proximal reflux of liquid embolic agents remains a primary safety concern during endovascular embolization, yet the quantitative relationships governing reflux mechanics are poorly characterized. An analytical model was developed to determine the relative contributions of catheter geometry, agent viscosity, polymerization kinetics, and injection technique to reflux behavior of ethylene\u2013vinyl alcohol copolymer (EVOH).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An annular Poiseuille flow model was constructed for a 1\u00a0mm vessel with coaxial microcatheters (1.3\u20132.8 French; catheter-to-vessel diameter ratio D*\u2009=\u20090.43\u20130.92). Carreau rheology was applied to EVOH-18 and EVOH-34; blood and iodinated contrast were modeled as Newtonian. Extensions incorporated vessel compliance, first-order EVOH polymerization kinetics, and intermittent injection parameterized by duty cycle \u03b4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The annular geometry function \u03c6(D*) spanned three orders of magnitude across the catheter range (0.179 to 0.0006), surpassing the maximum 2.4-fold inter-agent viscosity difference. At injection shear rates, EVOH-18 thinned to near-contrast viscosity (6.4 vs 6.1\u00a0mPa\u00b7s). EVOH polymerization reduced reflux up to 68% at low D* but was negligible at D*\u2009&gt;\u20090.9. Under intermittent injection (\u03b4\u2009=\u20090.20), effective reflux lengths fell up to tenfold, and the protective advantage of EVOH-34 over contrast increased from 1.35-fold to 4.1-fold.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Catheter-to-vessel geometry dominates reflux by orders of magnitude over viscosity; catheter selection is the primary modifiable safety determinant. EVOH polymerization provides geometrically selective secondary protection maximized by intermittent injection. The duty cycle \u03b4 is proposed as a standardizable parameter for reporting injection protocols.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42155-026-00693-9","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T03:45:26Z","timestamp":1779248726000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Why catheter size matters more than viscosity in ethylene\u2013vinyl alcohol copolymer reflux: an analytical study"],"prefix":"10.1186","volume":"9","author":[{"given":"Arthur A.","family":"Cornelis","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruben","family":"Geevarghese","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen B.","family":"Solomon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1058-0884","authenticated-orcid":false,"given":"Francois H.","family":"Cornelis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"issue":"4","key":"693_CR1","doi-asserted-by":"publisher","first-page":"681","DOI":"10.3174\/ajnr.A6453","volume":"41","author":"A Sirakov","year":"2020","unstructured":"Sirakov A, Minkin K, Sirakov S. Intermixed dimethyl-sulfoxide-based nonadhesive liquid embolic agents delivered serially via the same microcatheter for cerebral AVM treatment. AJNR Am J Neuroradiol. 2020;41(4):681\u20136. https:\/\/doi.org\/10.3174\/ajnr.A6453.","journal-title":"AJNR Am J Neuroradiol"},{"issue":"3","key":"693_CR2","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1055\/s-0031-1284462","volume":"28","author":"M Guimaraes","year":"2011","unstructured":"Guimaraes M, Wooster M. Onyx (ethylene-vinyl alcohol copolymer) in peripheral applications. Semin Intervent Radiol. 2011;28(3):350\u20136. https:\/\/doi.org\/10.1055\/s-0031-1284462.","journal-title":"Semin Intervent Radiol"},{"key":"693_CR3","doi-asserted-by":"publisher","unstructured":"Weber W, Kis B, Siekmann R, Jans P, Laumer R, K\u00fchne D. Preoperative embolization of intracranial arteriovenous malformations with Onyx. Neurosurgery. 2007;61(2):244\u201352; discussion 252\u2013254. https:\/\/doi.org\/10.1227\/01.NEU.0000255473.60505.84 PubMed PMID: 17762736.","DOI":"10.1227\/01.NEU.0000255473.60505.84"},{"issue":"3","key":"693_CR4","doi-asserted-by":"publisher","first-page":"280","DOI":"10.21037\/qims.2018.04.03","volume":"8","author":"R N\u00e9","year":"2018","unstructured":"N\u00e9 R, Chevallier O, Falvo N, Facy O, Berthod PE, Galland C, et al. Embolization with ethylene vinyl alcohol copolymer (Onyx\u00ae) for peripheral hemostatic and non-hemostatic applications: a feasibility and safety study. Quant Imaging Med Surg. 2018;8(3):280\u201390. https:\/\/doi.org\/10.21037\/qims.2018.04.03.","journal-title":"Quant Imaging Med Surg"},{"issue":"4","key":"693_CR5","doi-asserted-by":"publisher","DOI":"10.3390\/medicina59040710","volume":"59","author":"R Minici","year":"2023","unstructured":"Minici R, Venturini M, Fontana F, Guzzardi G, Pingitore A, Piacentino F, et al. Efficacy and safety of ethylene-vinyl alcohol (EVOH) copolymer-based non-adhesive liquid embolic agents (NALEAs) in transcatheter arterial embolization (TAE) of acute non-neurovascular bleeding: a multicenter retrospective cohort study. Medicina Kaunas. 2023;59(4):710. https:\/\/doi.org\/10.3390\/medicina59040710.","journal-title":"Medicina Kaunas"},{"issue":"5","key":"693_CR6","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1055\/s-2003-44551","volume":"29","author":"OK Baskurt","year":"2003","unstructured":"Baskurt OK, Meiselman HJ. Blood rheology and hemodynamics. Semin Thromb Hemost. 2003;29(5):435\u201350. https:\/\/doi.org\/10.1055\/s-2003-44551.","journal-title":"Semin Thromb Hemost"},{"key":"693_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.physrep.2026.01.003","volume":"1168","author":"S Ahmad","year":"2026","unstructured":"Ahmad S, Zeb S, Sun Y, Guo H, Qiao Y. Non-newtonian rheological aspects of blood in computational hemodynamics. Phys Rep. 2026;1168:1\u201324. https:\/\/doi.org\/10.1016\/j.physrep.2026.01.003.","journal-title":"Phys Rep"},{"key":"693_CR8","unstructured":"Viscous Fluid Flow (Mcgraw Hill Series in mechanical engineering): White, Frank M.: 9780072402315: Amazon.com: Books [Internet]. [cited 2026 Mar 3]. Available from: https:\/\/www.amazon.com\/Viscous-Fluid-MCGRAW-MECHANICAL-ENGINEERING\/dp\/0072402318"},{"issue":"Suppl 1","key":"693_CR9","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1177\/15910199050110S117","volume":"11","author":"R Siekmann","year":"2005","unstructured":"Siekmann R. Basics and principles in the application of onyx LD liquid embolic system in the endovascular treatment of cerebral arteriovenous malformations. Interv Neuroradiol. 2005;11(Suppl 1):131\u201340. https:\/\/doi.org\/10.1177\/15910199050110S117.","journal-title":"Interv Neuroradiol"},{"key":"693_CR10","doi-asserted-by":"crossref","unstructured":"Carreau, P.J. (1972) Rheological equations from molecular network theories. Transactions of the Society of Rheology, 16, 99\u2013127. - References - Scientific Research Publishing [Internet]. [cited 2026 Mar 3]. Available from: https:\/\/www.scirp.org\/reference\/referencespapers?referenceid=2762800","DOI":"10.1122\/1.549276"},{"key":"693_CR11","doi-asserted-by":"crossref","unstructured":"Laminar Craya\u2013Curtet jets | Physics of Fluids | AIP Publishing [Internet]. [cited 2026 Mar 3]. Available from: https:\/\/pubs.aip.org\/aip\/pof\/article-abstract\/16\/1\/208\/254937\/Laminar-Craya-Curtet-jets?redirectedFrom=fulltext","DOI":"10.1063\/1.1629300"}],"container-title":["CVIR Endovascular"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-026-00693-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s42155-026-00693-9","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s42155-026-00693-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T03:45:32Z","timestamp":1779248732000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s42155-026-00693-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,20]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["693"],"URL":"https:\/\/doi.org\/10.1186\/s42155-026-00693-9","relation":{},"ISSN":["2520-8934"],"issn-type":[{"value":"2520-8934","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,20]]},"assertion":[{"value":"9 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable. This study is a purely analytical and computational modeling study. No human participants, human data, human tissue, or animals were involved.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable. This manuscript does not contain any individual person's data in any form.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests. Francois H. Cornelis and Stephen B. Solomon are consultant for Microbot and General Electric Healthcare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"57"}}