Majid Maybody1, David C Madoff2, Raymond H Thornton3, Steven A Morales4, Chaya S Moskowitz5, Meier Hsu6, Lynn A Brody7, Karen T Brown8, Anne M Covey9. 1. Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA. Electronic address: maybodym@mskcc.org. 2. Weill Cornell Medicine, Division of Interventional Radiology, 525 East 68th Street, P-518, New York, NY 10065, USA. Electronic address: dcm9006@med.cornell.edu. 3. Weill Cornell Medicine, Division of Interventional Radiology, 525 East 68th Street, P-518, New York, NY 10065, USA. Electronic address: thorntor@mskcc.org. 4. University of Iowa Hospitals and Clinics, Department of Radiology, 200 Hawkins Drive, Iowa City, IO 52242, USA. Electronic address: steven-morales@uiowa.edu. 5. Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, 485 Lexington Avenue, New York, NY 10017, USA. Electronic address: moskowc1@mskcc.org. 6. Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, 485 Lexington Avenue, New York, NY 10017, USA. Electronic address: hsum1@mskcc.org. 7. Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA. Electronic address: brodyl@mskcc.org. 8. Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA. Electronic address: brown6@mskcc.org. 9. Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA. Electronic address: coveya@mskcc.org.
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.
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.
Authors: Sonny Tucker; Vincent L Rowe; Rajeev Rao; Douglas B Hood; Donald Harrell; Fred A Weaver Journal: Ann Vasc Surg Date: 2005-09 Impact factor: 1.466