Pseudoaneurysms are among the most common complications of vascular access. Here’s a refresher on how to treat them with thrombin injection featuring interventional radiologist Dr. Gabriel Werder from Radiology Associates of Florida. Alongside host Dr. Chris Beck, Dr. Werder outlines both the clinical and procedural approach to thrombin injection for pseudoaneurysms.

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SYNPOSIS

This episode covers best practices for thrombin injection procedures, including preferred needle positioning techniques, sedation protocols, ultrasound evaluation, and follow-up care. The physicians discuss recent evidence supporting needle placement at the center of the sac from an inferior approach, and share specific cases that highlight the utility of balloon-assisted thrombin injections. Dr. Werder provides a detailed walkthrough of his technique, including contralateral femoral access, balloon oversizing, and preferences for a post-procedural run-off angiogram. The episode also touches on complex pseudoaneurysms with multiple sacs and learnings from several other unique cases.

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TIMESTAMPS

00:00 - Introduction
03:53 - Thrombin Injection Procedural Overview
08:14 - Procedure Setup and Execution
16:13 - Needle Positioning and Ultrasound Evaluation
18:47 - Handling Complex Pseudoaneurysms
19:20 - Balloon Occlusion Thrombin Injection
19:59 - Case Studies and Practical Insights
26:21 - Post-Procedure Care and Follow-Up
29:17 - Final Thoughts and Reflections

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RESOURCES

Kim et al. “Optimal thrombin injection method for the treatment of femoral artery pseudoaneurysm” - https://www.jthjournal.org/article/S1538-7836(24)00048-5/fulltext