Ultrasound-Guided Thrombin Injection of a Pseudoaneurysm with Concomitant Deep Vein Thrombosis

The formation of a pseudoaneurysm (PSA) is one of the most common complications following arterial catheterization. These pseudoaneurysms have the potential to cause life-threatening complications. One such extremely uncommon complication is the development of deep vein thrombosis (DVTs). Successful treatment of a PSA can be hindered in patients receiving anticoagulants and special considerations are necessary in such cases. We present a 70-year-old female who developed a postarterial catheterization PSA which was treated with Ultrasound-Guided Thrombin Injection (UGTI) while the patient was receiving apixaban for treatment of a PSA-induced DVT. Peri-procedural imaging helped correctly identify this complex pathology, guide thrombin injection, and observe in real-time instantaneous thrombosis of the PSA while confirming adjacent femoral artery patency. Given the risk of associated complications, patients with a PSA who are receiving anticoagulation should undergo an UGTI for PSA closure. Anticoagulation may cause difficulty in achieving complete thrombosis of PSAs, but recent research has suggested that UGTI remains the preferred method with high overall success rates. Patients receiving anticoagulation undergoing this procedure may benefit from serial postprocedure duplex scans to assess for incomplete PSA closure, thrombosis, or recurrence.