Thrombin injection for the treatment of worsening brachiocephalic fistula pseudoaneurysm

An 86-year-old woman with end-stage renal disease was being dialyzed via a left brachiocephalic arteriovenous fistula. She developed a pseudoaneurysm at one of the angioaccess sites that did not resolve spontaneously. She developed significant pain and discomfort and presented for treatment. Ultrasound evaluation identified and characterized the pseudoaneurysm. Thrombin injection with ultrasound guidance successfully resolved the pseudoaneurysm, and at her follow-up her symptoms has resolved. Although off-label, thrombin injection remains an important tool in the management of pseudoaneurysms, no matter the location.