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Maybody M, Madoff DC, Thornton RH, Morales SA, Moskowitz CS, Hsu M, Brody LA, Brown KT, Covey AM. Catheter-directed endovascular application of thrombin: Report of 3 cases and review of the literature. Clin Imaging 2017; 42:96-105. [PMID: 27936421 PMCID: PMC5499980 DOI: 10.1016/j.clinimag.2016.11.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/15/2016] [Accepted: 11/28/2016] [Indexed: 01/08/2023]
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.
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Affiliation(s)
- Majid Maybody
- Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA.
| | - David C Madoff
- Weill Cornell Medicine, Division of Interventional Radiology, 525 East 68th Street, P-518, New York, NY 10065, USA.
| | - Raymond H Thornton
- Weill Cornell Medicine, Division of Interventional Radiology, 525 East 68th Street, P-518, New York, NY 10065, USA.
| | - Steven A Morales
- University of Iowa Hospitals and Clinics, Department of Radiology, 200 Hawkins Drive, Iowa City, IO 52242, USA.
| | - Chaya S Moskowitz
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, 485 Lexington Avenue, New York, NY 10017, USA.
| | - Meier Hsu
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, 485 Lexington Avenue, New York, NY 10017, USA.
| | - Lynn A Brody
- Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA.
| | - Karen T Brown
- Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA.
| | - Anne M Covey
- Memorial Sloan Kettering Cancer Center, Interventional Radiology Service, H1118, 1275 York Avenue, New York, NY 10065, USA.
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Zayed MA, Marshall C, Dake M, Lee JT. Plug the Hole--A Bailout Option for Acute Focal Aortic Rupture. Ann Vasc Surg 2015; 30:309.e5-9. [PMID: 26522581 DOI: 10.1016/j.avsg.2015.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 07/20/2015] [Accepted: 07/29/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Focal aortic rupture may result from expanding aneurysms, penetrating aortic wall ulcerations, or virulent infections. An urgent repair of paravisceral focal aortic rupture is associated with high morbidity. A staged repair approach may provide an alternative option. CASE REPORT A 64-year-old woman presented with acute focal rupture of the posterior paravisceral aortic wall and was progressing to hemorrhagic shock and mesenteric ischemia. Given the patient's dire condition, an endovascular approach was used to plug her focal aortic wall defect using a ventricular septal defect occluder device. Subsequently, the patient underwent resuscitation, stabilization, and operative exploration. Postoperatively, she recovered well from this staged approach. CONCLUSIONS This case provides an example of a staged endovascular plugging of an acute paravisceral focal aortic rupture. In select cases, this type of repair strategy is feasible, until off-the-shelf endovascular repair options become a reality.
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Affiliation(s)
- Mohamed A Zayed
- Department of Surgery, Section of Vascular Surgery, Washington University School of Medicine, St. Louis, MO; Department of Surgery, Division of Vascular Surgery, Veterans Affairs St. Louis Health Care System, St. Louis, MO.
| | - Clement Marshall
- Division of General Surgery, Stanford University Medical Center, Stanford, CA
| | - Michael Dake
- Department of Cardiac Surgery, Stanford University Medical Center, Stanford, CA
| | - Jason T Lee
- Division of Vascular Surgery, Stanford University Medical Center, Stanford, CA
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Vidjak V, Novacic K, Slavica M. Embolisation of posttraumatic superior mesenteric artery pseudoaneurysm in a patient with short bowel syndrome preceding bowel transplantation. Case Rep Radiol 2011; 2011:539340. [PMID: 22606549 PMCID: PMC3350133 DOI: 10.1155/2011/539340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 06/13/2011] [Indexed: 11/17/2022] Open
Abstract
Penetrating abdominal trauma often causes bowel injuries which may lead to "short bowel syndrome" which is a potential indication for bowel transplantation. Posttraumatic pseudoaneurysms of abdominal arteries are often a result of penetrating abdominal trauma. We report a successful embolisation of posttraumatic superior mesenteric artery (SMA) branch pseudoaneurysm using microcoil, in a patient with short bowel syndrome who was successfully transplanted three months after embolisation.
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Affiliation(s)
- Vinko Vidjak
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Merkur, Zajceva 19, 10000 Zagreb, Croatia
| | - Karlo Novacic
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Merkur, Zajceva 19, 10000 Zagreb, Croatia
| | - Marko Slavica
- Department of Diagnostic and Interventional Radiology, Clinical Hospital Merkur, Zajceva 19, 10000 Zagreb, Croatia
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Wallace MJ, Choi E, McRae S, Madoff DC, Ahrar K, Pisters P. Superior mesenteric artery pseudoaneurysm following pancreaticoduodenectomy: management by endovascular stent-graft placement and transluminal thrombin injection. Cardiovasc Intervent Radiol 2007; 30:518-22. [PMID: 17031732 DOI: 10.1007/s00270-006-0109-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Superior mesenteric artery (SMA) pseudoaneurysm formation is a rare and potentially fatal postoperative complication. Herein we present a case of a large post-pancreaticoduodenectomy SMA pseudoaneurysm that required thrombin injection after initial stent-graft deployment to accomplish complete pseudoaneurysm occlusion.
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Affiliation(s)
- Michael J Wallace
- Department of Diagnostic Radiology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA.
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Dregelid E, Jenssen G, Jonung T, Braaten A. Pseudoaneurysm of the abdominal aorta due to a needle-like osteophyte on the first lumbar vertebra. J Vasc Surg 2007; 45:1059-61. [DOI: 10.1016/j.jvs.2006.12.070] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 12/28/2006] [Indexed: 12/01/2022]
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Williams M, Alderson D, Virjee J, Callaway M. CT-guided percutaneous thrombin injection for treatment of an inferior pancreaticoduodenal artery pseudoaneurysm. Cardiovasc Intervent Radiol 2006; 29:669-71. [PMID: 16604412 DOI: 10.1007/s00270-004-0274-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We present a case of an inferior pancreaticoduodenal artery pseudoaneurysm treated by computed tomography (CT)-guided percutaneous injection of thrombin. As far as we are aware, we present the first documented case of successful long-term (9 months) follow-up with no evidence of recurrence.
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Affiliation(s)
- Marc Williams
- Department of Surgery, Bristol Royal Infirmary, Bristol, UK
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Geckeis K, Eggebrecht H, Schmermund A, Kühl H, Niebel W, Omlor G, Erbel R. Percutaneous Repair of Abdominal Aortic Pseudoaneurysm by Catheter-Based Delivery of Thrombin. J Endovasc Ther 2006; 13:264-8. [PMID: 16643084 DOI: 10.1583/05-1767r.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To present a case in which thrombin was injected percutaneously to treat an aortic pseudoaneurysm. CASE REPORT A 63-year-old man developed a large pseudoaneurysm in the abdominal aorta after surgical fenestration and patch aortoplasty for acute type B aortic dissection with malperfusion syndrome. Transcatheter delivery of 1500 units of thrombin resulted in complete thrombosis of the pseudoaneurysm sac. No complications occurred. Twelve months after the procedure, the pseudoaneurysm was completely resolved on computed tomography. CONCLUSION Thrombin continues to prove its safety and efficacy for the treatment of pseudoaneurysms at numerous anatomical sites, including the abdominal aorta.
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Affiliation(s)
- Katrin Geckeis
- Department of Cardiology, West-German Heart Center Essen, Germany.
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Oechsle S, Vollert K, Buecklein W, Michl W, Roemer FW. Percutaneous treatment of a ruptured superior mesenteric artery aneurysm in a child. Pediatr Radiol 2006; 36:268-71. [PMID: 16432702 DOI: 10.1007/s00247-005-0078-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2005] [Revised: 11/13/2005] [Accepted: 11/14/2005] [Indexed: 10/25/2022]
Abstract
Splanchnic artery aneurysms are very rare in children. We report a 10-year-old girl with a large atraumatic ruptured superior mesenteric artery aneurysm that was considered inoperable. She was ultimately treated with two percutaneous US-guided thrombin injections, which led to complete occlusion of the aneurysm. The aetiology of the aneurysm remained unclear, but a family history was suggestive of a congenital connective tissue disease such as Ehlers-Danlos syndrome subtype IV.
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Affiliation(s)
- Susanne Oechsle
- Department of Radiology, Klinikum Augsburg, Stenglinstrasse 2, 86156 Augsburg, Germany.
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Aalami OO, Lisagor P, Victorino GP, McDaniel H, Nikolic B. Repair of Iatrogenic Subclavian Artery Pseudoaneurysm with Covered Stent Placement after Vertebral Artery Transposition. J Vasc Interv Radiol 2005; 16:1759-60. [PMID: 16371547 DOI: 10.1097/01.rvi.0000183218.10115.82] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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