BackTable Vascular & Interventional Ep. 596 Thrombin Injection for Pseudoaneurysms: Technique & Considerations with Dr. Gabriel Werder
Dec 9, 2025
Dr. Gabriel Werder, an interventional radiologist from Florida, shares his expertise on thrombin injection for treating pseudoaneurysms. He discusses essential procedural techniques, including optimal needle positioning and sedation protocols. The conversation highlights unique cases, balloon-assisted methods, and managing complex pseudoaneurysms. Werder also emphasizes the importance of comprehensive ultrasound assessments and tailored post-procedure care to ensure successful outcomes. Tune in for practical insights and best practices that can enhance your understanding of vascular intervention!
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Treat It Like A Full Procedure
- Use a sterile gown, mask, gloves and full prep for thrombin injections just like any angiographic case.
- Use a styleted spinal needle (21–22G) to avoid clot formation in the barrel and reduce injection force.
Thrombin Works Beyond Femoral Sites
- While femorals are the most common pseudoaneurysm site, thrombin injection works in radials, pedal, and unusual locations like intercostal or rectus sheath.
- Having a low threshold to try ultrasound-guided thrombin can simplify management versus complex endovascular approaches.
Tingling After Injection Prompted Overnight Hold
- Werder recalled a patient reporting foot tingling after thrombin injection despite normal Doppler signals, so he kept the patient on heparin overnight.
- The patient did well and illustrates cautious observation when new symptoms appear.