Recurrence of Thrombin-Injected Pseudoaneurysms Under Ultrasound Guidance: A 10-Year Retrospective Analysis

Yonah B. Esterson, John S. Pellerito

Research output: Contribution to journalArticlepeer-review


OBJECTIVES: Ultrasound-guided thrombin injection has become standard treatment for extremity pseudoaneurysms. Our specific aims were to determine the procedural success rate, the procedural complication rate, and the factors associated with pseudoaneurysm recurrence.

METHODS: A total of 262 consecutive cases of ultrasound-guided thrombin repair of pseudoaneurysms were identified between January 1, 2006, and March 20, 2016. The procedural and follow-up ultrasound studies were reviewed. Outcomes of interest included procedural success (defined as complete thrombosis at the time of injection and on a follow-up examination), incomplete pseudoaneurysm thrombosis, and postprocedural recurrence. Postprocedural pseudoaneurysm recurrences were compared to procedural successes with regard to patient demographics, pseudoaneurysm characteristics, amount of thrombin injected, and periprocedural laboratory values.

RESULTS: Procedural success occurred in 85.7% of cases. Complications occurred in 3.0% of cases. The mean patient age ± SD was 72.3 ± 11.3 years. The median amount of thrombin injected was 500 U (interquartile range, 400 U). The median follow-up time was 1 day (interquartile range, 0 days). A pseudoaneurysm size of 2 cm or larger and thrombocytopenia were significant independent predictors of pseudoaneurysm recurrence (P = .003 and .03, respectively). The odds ratios for pseudoaneurysm recurrence were 2.29 for pseudoaneurysm size of 2 cm or larger (P = .03) and 1.04 for thrombocytopenia (P = .04).

CONCLUSIONS: Thrombin injection of pseudoaneurysms is an off-label procedure with few complications and a high success rate. Follow-up imaging is recommended in all pseudoaneurysms that are 2 cm or larger and in patients with thrombocytopenia.

Original languageEnglish (US)
Pages (from-to)1617-1624
Number of pages8
JournalJournal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
Issue number8
StatePublished - Aug 1 2017
Externally publishedYes


  • interventional-intraoperative ultrasound
  • pseudoaneurysm
  • pseudoaneurysm recurrence
  • thrombin
  • ultrasound-guided treatment

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

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