Abstract No. 525 - Initial experience with the AngioVac aspiration system

Abstract

To present our experience with the AngioVac aspiration system, a new device designed for removal of intravascular material, such as thrombi and vegetations To review the available literature on AngioVac aspiration system The AngioVac system (AngioDynamics, Latham, NY) is a novel mechanical suction device that is designed for the removal of unwanted intravascular material while maintaining flow during extracorporeal circulation. It has been described for use in the retrieval of right atrial thrombus/mass, management of acute massive pulmonary embolism, treatment of symptomatic iliocaval thrombosis, protection against thrombus migration during catheter removal in right to left cardiac shunts, and removal of cardiovascular implantable device lead vegetations. The current case series describes the use of AngioVac in 6 consecutive patients. There were 3 female and 3 males (mean age, 49.6 y). In 5/6 cases, the AngioVac cannula was inserted percutaneously and the patient was placed on veno-venous bypass. In one of the cases, the cannula was inserted directly into the Fontan circuit after sternotomy and the patient was maintained on cardiopulmonary bypass. Thrombus location included iliocaval (2), pulmonary arteries (PA) (1), Fontan circuit and Glenn shunt with pulmonary artery extension (1), right atrium (RA) (1), and IVC with renal vein extension (1). Near complete evacuation of thrombus was documented in 3/6 cases by angiogram, cross sectional imaging or intravascular ultrasound. Partial thrombus removal was confirmed in 3/6 patients. Reasons for subtotal thrombus removal included chronic thrombus (2) and inadequate suction cannula flow rates in the pulmonary arteries (1). 2/6 patients had access site hematomas which resolved without any interventions. PubMed search yielded 12 studies reporting experience with a total of 29 patients, which will be reviewed in a table format as provided below (Table 1). AngioVac is a useful tool for acute thrombus removal in the large vessels. More studies needed to establish the utility of AngioVac in treatment of intravascular and intracardiac material.