Objective To investigate the influencing factors associated with the efficacy of pseudoaneurysm (PSA) closure using ultrasound-guided compression repair versus thrombin injection. Methods To retrospectively analyze the clinical and ultrasound data of patients who attended and received ultrasound-guided compression repair (UGCR) and ultrasound-guided thrombin injection ( UGTI) at Yantai Yuhuangding Hospital from January 2018 to December 2022. The UGCR group was divided into successful and unsuccessful groups according to whether the treatment was successful

and the UGTI group was divided into once-treatment and multiple-treatment groups according to the times of treatment. Single-factor and multi-factor analyses were applied to analyze the relevant influencing factors affecting the treatment effect of PSA. Results Univariate analysis showed that the time interval between arterial puncture to treatment (t)

neck inflow velocity of PSA >200 cm/s and t >4 days were statistically significant differences between the successful and unsuccessful UGCR groups (P < 0.05). Multifactorial Logistic analysis showed that neck inflow velocity >200 cm/s（OR=1.015，95%CI=1.007-1.023）and t >4 days（OR=1.324，95%CI=1.116-1.570）were independent risk factors for UGCR treatment failure (P<0.05). Conclusion t > 4 days and neck inflow velocity > 200 cm/s are factors influencing the failure of PSA treatment with UGCR. Paying attention to neck inflow velocity and t can help to predict the efficacy of UGCR and to perform UGTI in time to improve the success rate of PSA treatment.