BackTable Vascular & Interventional Ep. 596 Thrombin Injection for Pseudoaneurysms: Technique & Considerations with Dr. Gabriel Werder
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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.
Dilute And Titrate Thrombin Carefully
- Dilute the 5,000-unit thrombin kit into a 5 mL syringe and draw doses into a 1 mL syringe for precise aliquots.
- Start with small aliquots (often 250–500 units) and inject slowly under ultrasound guidance.
Use Lidocaine; Sedate When Needed
- Use local lidocaine for everyone and reserve sedation for very painful or uncooperative patients.
- Be liberal with sedation when body habitus or tenderness makes positioning and comfort difficult.