Patients who have undergone a mechanical thrombectomy and experience a “whooshing” or “swishing” sound, known as pulsatile bruit, along with pain in the groin area, may be experiencing a specific complication. This article aims to clarify what these symptoms might indicate for individuals who have had a mechanical thrombectomy, providing general information for understanding.
About Mechanical Thrombectomy
Mechanical thrombectomy is a minimally invasive procedure designed to remove blood clots from arteries or veins. It is commonly performed for conditions such as ischemic stroke, where a clot blocks blood flow to the brain, or deep vein thrombosis, which involves blood clots in the legs or arms. The process typically involves inserting a thin, flexible tube called a catheter into an artery, often in the groin area, and guiding it to the location of the blood clot.
Once the catheter reaches the clot, a specialized device, such as a stent retriever or a suction device, is used to capture and remove the thrombus, restoring blood flow. This procedure is performed by interventional radiologists or neuro-interventionalists using real-time imaging like X-rays (fluoroscopy) to navigate the blood vessels. While the procedure itself is precise, the insertion site in the groin, usually the femoral artery, is where potential complications can arise.
Understanding the Symptoms
Pulsatile bruit refers to a “whooshing” or “swishing” sound that can be heard over a blood vessel. This sound is rhythmic and typically pulses in sync with the heartbeat, much like a fetal heartbeat. Patients can perceive it as a rhythmic noise or even feel a vibration over the affected area. This sound indicates turbulent blood flow.
Groin pain is localized discomfort or tenderness in the area where the catheter was inserted during the thrombectomy. This pain can range from mild to severe, and it might be persistent or worsen over time. While some minor discomfort or bruising is normal after a catheterization procedure, the combination of pulsatile bruit and persistent or increasing groin pain after a mechanical thrombectomy is a significant signal that requires medical attention.
The Likely Complication
When pulsatile bruit and groin pain occur together following a mechanical thrombectomy, the most likely complication signaled is a femoral pseudoaneurysm. A pseudoaneurysm, also known as a false aneurysm, is a collection of blood that has leaked out of an artery but is contained by the surrounding tissues, forming a pulsating hematoma. This differs from a true aneurysm, where the artery wall itself bulges.
A pseudoaneurysm typically forms due to incomplete sealing of the arterial puncture site after the catheter is removed, allowing blood to escape the vessel. The pulsatile bruit is a direct result of the turbulent blood flow in and out of this contained blood collection. The groin pain arises because the expanding pseudoaneurysm presses on nearby nerves and tissues in the tight space of the groin. While less common, another vascular complication called an arteriovenous (AV) fistula could also cause a bruit, as it involves an abnormal connection between an artery and a vein. However, the localized groin pain strongly points to a pseudoaneurysm due to the contained blood collection.
Next Steps for Patients
If you experience pulsatile bruit and groin pain after a mechanical thrombectomy, seeking immediate medical evaluation is important. These symptoms are not typical post-procedure discomfort and warrant professional assessment. A healthcare provider will usually perform a physical examination, looking for a painful, pulsating lump at the catheter insertion site.
The primary diagnostic tool for confirming a pseudoaneurysm or other vascular issues is an ultrasound of the groin area. This imaging technique allows visualization of blood flow and can determine the size and location of any blood collection.
Management approaches for pseudoaneurysms can vary based on their size and characteristics. Small, stable pseudoaneurysms may be observed, as some can clot spontaneously. Larger or symptomatic ones may require ultrasound-guided compression, where pressure is applied to the pseudoaneurysm to encourage clotting, or ultrasound-guided thrombin injection, which involves injecting a clotting agent directly into the pseudoaneurysm. In certain cases, surgical repair may be necessary. The appropriate treatment plan will depend on the specific findings and the patient’s overall health.