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

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 pseu-doaneurysm 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 inter-est 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, pseudoan-eurysm 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 6 SD was 72.3 6 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 5 .003 and .03, respectively). The odds ratios for pseudoaneurysm recurrence were 2.29 for pseudoaneurysm size of 2 cm or larger (P 5 .03) and 1.04 for thrombocytopenia (P 5 .04). Conclusions—Thrombin injection of pseudoaneurysms is an off-label procedure with few complications and a high success rate. Follow-up imaging is recom-mended in all pseudoaneurysms that are 2 cm or larger and in patients with thrombocytopenia.