Catheter-directed endovascular application of thrombin: Report of 3 cases and review of the literature Journal Article
| Authors: | Maybody, M.; Madoff, D. C.; Thornton, R. H.; Morales, S. A.; Moskowitz, C. S.; Hsu, M.; Brody, L. A.; Brown, K. T.; Covey, A. M. |
| Article Title: | Catheter-directed endovascular application of thrombin: Report of 3 cases and review of the literature |
| Abstract: | Purpose To report 3 new cases of catheter-directed endovascular application of thrombin and explore trends by analysis of published case series. Materials and methods Institutional Review Board approved this retrospective study. All cases of non-tumoral arterial embolization performed from January 2003 to January 2015 at our institution were retrospectively reviewed. Thrombin was used in 7 of 589 cases. In 3 cases intra arterial thrombin was injected via catheter to treat active hemorrhage. Four cases were excluded due to percutaneous injection into visceral pseudoaneurysms (n = 3) and making ex vivo autologous clot to be injected via catheter (n = 1). Fisher's exact and the Wilcoxon rank sum tests were used to assess for association with acute nontarget thrombosis. Results Catheter-directed thrombin was used in 3/589 (0.5%) cases at our institution. All three cases were technically successful with no further bleeding (100%). Nontarget thrombosis of proximal branches occurred in 2 patients (67%) with no significant clinical consequences. Including our 3 cases, a total of 28 cases were reviewed. Of the variables examined—location (p = 0.99), size (p = 0.66) and etiology of vascular lesion (p = 0.92), pseudoaneurysm neck anatomy (p = 0.14), thrombin units (p = 0.47), volume (p = 0.76) or technique of use of small doses (p = 0.99), use of other embolic material (p = 0.67) and use of adjunct techniques (p = 0.99)—none were found to be significantly associated with acute nontarget thrombosis. Technical success was 96% with no reports of reperfusion after treatment. Conclusions Catheter-directed endovascular thrombin can be an additional tool to treat pseudoaneurysms not amenable to conventional embolization. Further studies are required to optimize technique and outcomes. © 2016 Elsevier Inc. |
| Keywords: | thrombosis; diseases; enzymes; blood vessels; thrombin; vascular lesions; wilcoxon rank sum test; arterial embolization; catheters; pseudoaneurysm; institutional review boards; endovascular; catheter-directed |
| Journal Title: | Clinical Imaging |
| Volume: | 42 |
| ISSN: | 0899-7071 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2017-03-01 |
| Start Page: | 96 |
| End Page: | 105 |
| Language: | English |
| DOI: | 10.1016/j.clinimag.2016.11.018 |
| PROVIDER: | scopus |
| PUBMED: | 27936421 |
| PMCID: | PMC5499980 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 January 2017 -- Source: Scopus |
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