Percutaneous Vacuum-Assisted Thrombectomy for Right Atrial Mass

Abstract

CATHETER-RELATED right atrial thrombi (CRAT) and right heart thrombi (RiHT) can have devastating complications secondary to pulmonary embolism (PE) if left untreated. 1 Barrios D Rosa-Salazar V Jiménez D et al. Right heart thrombi in pulmonary embolism. Eur Respir J. 2016; 48: 1377-1385 Crossref PubMed Scopus (33) Google Scholar ,2 Rose PS Punjabi NM Pearse DB. Treatment of right heart thromboemboli. Chest. 2002; 121: 806-814 Abstract Full Text Full Text PDF PubMed Scopus (296) Google Scholar Conventional therapy consists of oral and intravenous anticoagulation, catheter-directed thrombolytics, and surgical embolectomy. However, these therapies are not always successful or carry significant risk of periprocedural complications and mortality. 1 Barrios D Rosa-Salazar V Jiménez D et al. Right heart thrombi in pulmonary embolism. Eur Respir J. 2016; 48: 1377-1385 Crossref PubMed Scopus (33) Google Scholar ,3 Tran MH Wilcox T Tran PN. Catheter-related right atrial thrombosis. J Vasc Access. 2020; 21: 300-307 Crossref PubMed Scopus (11) Google Scholar ,4 Stein PD Alnas M Beemath A et al. Outcome of pulmonary embolectomy. Am J Cardiol. 2007; 99: 421-423 Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar The AngioVac (Angiodynamics, Latham, NY) device is a potentially safe and effective alternative to conventional therapy. 5 Hameed I Lau C Khan FM et al. AngioVac for extraction of venous thromboses and endocardial vegetations: A meta-analysis. J Card Surg. 2019; 34: 170-180 Crossref PubMed Scopus (20) Google Scholar ,6 Moriarty JM Rueda V Liao M et al. Endovascular removal of thrombus and right heart masses using the AngioVac system: Results of 234 patients from the prospective, multicenter registry of AngioVac procedures in detail (RAPID). J Vasc Interv Radiol. 2021; 32: 549-557 Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar The AngioVac is a vacuum-assisted thrombectomy device that uses a venovenous extracorporeal circuit to generate negative pressure through a specialized 22-F expandable funnel-tipped catheter in order to aspirate thrombi, emboli, or other masses in the major veins, right heart chambers, and pulmonary artery. The authors present a case of a 40-year-old woman with metastatic adrenocortical carcinoma and a CRAT who was treated with the AngioVac device.