Clinical StudyRemoval of Caval and Right Atrial Thrombi and Masses Using the AngioVac Device: Initial Operative Experience
Section snippets
Materials and Methods
The medical center institutional review board approved this retrospective study. An analysis of patient demographics, procedural details, and outcomes was performed. All cases of AngioVac thrombectomy for nonpulmonary embolic indications, including right atrial masses and thrombi and iliocaval thrombi between August 2013 and January 2015 were reviewed. Contrast-enhanced computed tomography, contrast-enhanced magnetic resonance imaging, ultrasound, or echocardiography studies were obtained
Results
Percutaneous access was achieved in all cases. Procedural success was achieved in four of six (67%) cases of atrial masses and thrombi and 10 of 10 (100%) cases of caval thrombi. The two procedural failures were cases of right atrial sarcoma and tricuspid valve vegetation associated with a cardiac device lead. Average fluoroscopy time was 33.1 minutes ± 22.3 (range, 3.8–87.2 min). Adjunctive procedures were performed at the discretion of the proceduralist and included venoplasty (n = 4),
Discussion
Intravascular and cardiac thrombi and masses are traditionally managed medically or with open surgery, and most intracardiac masses still require surgical excision (17). However, intravascular masses may now be increasingly managed with endovascular techniques. Although catheter-directed thrombolysis has become a frequently used approach to thrombosis management, there are common clinical scenarios in which thrombolysis is not feasible and aspirational devices are a safe alternative. Donaldson
References (24)
- et al.
Catheter-directed interventions for acute iliocaval deep vein thrombosis
Tech Vasc Interv Radiol
(2014) Iliocaval reconstruction in chronic deep vein thrombosis
Tech Vasc Interv Radiol
(2014)- et al.
Treatment of right heart thromboemboli
Chest
(2002) - et al.
Utilization of AngioVac and snare for eradication of a mobile right atrial thrombus
Ann Thorac Surg
(2015) - et al.
Successful management of acute massive pulmonary embolism using Angiovac suction catheter technique in a hemodynamically unstable patient
Cardiovasc Revasc Med
(2014) - et al.
Vacuum-assisted thrombectomy device (AngioVac) in the management of symptomatic iliocaval thrombosis
J Vasc Interv Radiol
(2014) - et al.
Percutaneous extraction of right atrial mass using the Angiovac aspiration system
J Vasc Interv Radiol
(2011) - et al.
Society of Interventional Radiology clinical practice guidelines
J Vasc Interv Radiol
(2003) - et al.
Transvenous lead extraction: Heart Rhythm Society expert consensus on facilities, training, indications, and patient management: this document was endorsed by the American Heart Association (AHA)
Heart Rhythm
(2009) The epidemiology of venous thromboembolism in the community
Arterioscler Thromb Vasc Biol
(2008)
AngioVac aspiration for paradoxical emboli protection through a fenestrated Fontan during central venous thrombus manipulation
Cardiovasc Intervent Radiol
Novel use of AngioVac system to prevent pulmonary embolism during radical nephrectomy with inferior vena cava thrombectomy
Curr Urol
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2024, Current Problems in CardiologyNavigating the Heart. The Evolution of the AngioVac System in a Single-center Experience
2023, Current Problems in CardiologyCitation Excerpt :The primary endpoints were to evaluate the efficacy and safety of the device. The efficacy was defined by the aspiration of >70% of the mass as displayed on intraoperative transesophageal echocardiography, according to previous publications2,16,17. Safety was defined by the rate of procedural and device-related complications, including death during or within 24 hours from the procedure, cardiac valve damage, cardiac perforation, arrhythmias requiring treatment, access site complications, major bleedings, and mass embolization2.
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2022, Revista Portuguesa de CardiologiaDebulking challenging large volume intracardiac and intravascular thrombus with the AngioVac system
2022, Debulking in Cardiovascular Interventions and Revascularization Strategies: Between a Rock and the HeartAngioVac Aspiration Thrombectomy of Right Atrial Thrombus is Safe and Effective in Cancer Patients
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J.M.M. is a paid consultant for AngioDynamics, Inc (Latham, New York). None of the other authors have identified a conflict of interest.
From the SIR 2015 Annual Meeting.