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.
New oral anticoagulants (NOAC) are the latest addition to anticoagulant armamentarium. Unlike traditional anti-coagulants like warfarin, lab monitoring and management of bleeding complications secondary to these agents is different. As more and more patients are being switched to these drugs, interventional radiologists in particular will benefit from a clinical review of NOAC.
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