title: Catheter-directed endovascular application of thrombin: Report of 3 cases and review of the literature.
abstract: OBJECTIVE
  To report 3 new cases of catheter-directed endovascular application of thrombin and explore trends by analysis of published case series.
  
  
  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.affiliation: Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA. Electronic address: maybodym@mskcc.org.
authors.forename: Majid
authors.initials: M
authors.lastname: Maybody
authors.affiliation: Weill Cornell Medicine, Division of Interventional Radiology, 525 East 68th Street, P-518, New York, NY 10065, USA. Electronic address: dcm9006@med.cornell.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Madoff
authors.affiliation: Weill Cornell Medicine, Division of Interventional Radiology, 525 East 68th Street, P-518, New York, NY 10065, USA. Electronic address: thorntor@mskcc.org.
authors.forename: Raymond H
authors.initials: RH
authors.lastname: Thornton
authors.affiliation: University of Iowa Hospitals and Clinics, Department of Radiology, 200 Hawkins Drive, Iowa City, IO 52242, USA. Electronic address: steven-morales@uiowa.edu.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Morales
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, 485 Lexington Avenue, New York, NY 10017, USA. Electronic address: moskowc1@mskcc.org.
authors.forename: Chaya S
authors.initials: CS
authors.lastname: Moskowitz
authors.affiliation: Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, 485 Lexington Avenue, New York, NY 10017, USA. Electronic address: hsum1@mskcc.org.
authors.forename: Meier
authors.initials: M
authors.lastname: Hsu
authors.affiliation: Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA. Electronic address: brodyl@mskcc.org.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Brody
authors.affiliation: Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA. Electronic address: brown6@mskcc.org.
authors.forename: Karen T
authors.initials: KT
authors.lastname: Brown
authors.affiliation: Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA. Electronic address: coveya@mskcc.org.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Covey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000188:drug therapy*; D000072226:Computed Tomography Angiography; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000188:drug therapy*; D006490:Hemostatics / Q000008:administration & dosage* / Q000627:therapeutic use; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D007267:Injections; D008297:Male; D012189:Retrospective Studies; D013917:Thrombin / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D013917:Thrombin
keywords: Catheter-directed; Endovascular; Pseudoaneurysm; Thrombin; Thrombosis