Clinical Study
Removal of Caval and Right Atrial Thrombi and Masses Using the AngioVac Device: Initial Operative Experience

https://doi.org/10.1016/j.jvir.2016.03.045Get rights and content

Abstract

Purpose

To describe initial single-center experience with a thrombectomy device in managing right atrial and caval thrombi, tumors, and vegetations.

Materials and Methods

A retrospective analysis of AngioVac thrombectomy performed in 16 patients (mean age 53 y ± 13; 8 men, 8 women) between August 2013 and August 2015 was performed. Indications included right atrial mass/thrombus (6/16; 37.5%) and iliocaval thrombus (10/16; 62.5%). Procedural success was defined as aspiration of > 70% volume of atrial mass/thrombus or restoration of antegrade caval flow.

Results

Procedural success was achieved in 4/6 (67%) right atrial masses/thrombi and 10/10 (100%) caval thrombi. All patients (8/8; 100%) with caval thrombus presenting with swelling/edema had improvement or resolution of symptoms. There were no procedural or periprocedural mortalities; complications included one major (6.3%; intraprocedural pulmonary embolus) and one minor (6.3%; access site hematoma not requiring transfusion) complication. Of 16 patients, 14 (87.5%) survived to discharge at a mean of 10 days ± 8 (range, 1–23 d), and 12 patients (75%) were alive at last known follow-up at a mean of 385 days ± 267 (range, 63–730 d). At a mean of 194 days ± 177 (range, 41–372 d), 4/16 (25%) patients were dead; no death was related to AngioVac thrombectomy. At a mean of 66 days ± 21 (range, 49–90 d) after intervention, 3/14 (21.4%) cases with procedural success had local recurrence of mass/thrombus.

Conclusions

AngioVac thrombectomy can be performed with high procedural success with clinical benefit in patients with right atrial and caval masses/thrombi.

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

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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.

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