Real-World Experience With the AngioVac Device

Abstract

The AngioVac system (AngioDynamics, Latham, NY) is a venous drainage cannula and circuit used for the removal of soft, fresh thromboemboli. Current literature suggests a promising role for the AngioVac system for treatment of central venous and right-sided heart thromboembolic disease; however, published data remain limited. Our goal was to present the results of a high-volume, single-center experience with the AngioVac device. We performed a retrospective review of all patients who underwent AngioVac suction thrombectomy from January 2012 to August 2016. Patient demographics, procedural details, and outcomes were collected. A total of 30 patients underwent AngioVac thromboembolectomy during the study period. Twenty-nine patients (96.7%) were treated for iliocaval vein thrombosis. One patient was treated for an isolated right atrial mass. Eighteen patients (60%) were female and 12 (40%) were male. The most common presenting symptoms were lower extremity swelling (83.3%) and lower extremity pain (66.7%). Eighteen patients (60.0%) had a pre-existing inferior vena cava (IVC) filter. Twenty-five patients (83.3%) presented with IVC thrombus, and of those, 16 (53.3%) were associated with the presence of an IVC filter. Twenty-five cases (83.3%) were performed during the initial hospital admission, with 7 cases (23.3%) performed within the first 24 hours. Fourteen patients (46.7%) initially received catheter-directed thrombolysis. Of those, seven (50%) had suboptimal thrombus clearance and seven (50%) had cessation of thrombolysis because of low fibrinogen or clinically significant bleeding. The average time from admission to intervention was 3 ± 3 days. The average time from symptom onset to intervention was 10 ± 7 days. The average procedure time was 125 ± 51 minutes. The IVC filter was removed in 10 of 25 patients (40%). Restoration of inline venous outflow was obtained in all patients. AngioVac was used as stand-alone therapy in 7 patients; 23 required other adjunctive methods. Iliac and IVC angioplasty was the most frequently used adjuvant therapy. Intraoperative transfusion was required in seven patients (23.3%). Postoperative transfusion was required in five patients (16.7%). Access site complications occurred in five patients (16.7%). One patient had a pulmonary embolism during the procedure and died. Average postoperative hospital stay was 5 ± 4 days. Mean follow-up was 7.2 ± 6.1 months. At last follow-up, 28 of 29 iliocaval patients reported improvement in symptoms. Six patients (20.0%) required reintervention. Late interventions included venous angioplasty, stenting, and IVC filter removal. Average time to reintervention was 137 ± 62 days. Twenty-three of 29 (79.3%) patients alive at follow-up remained on anticoagulation. Recurrent venous thromboembolism occurred in five patients (16.7%) and was related to inadequate anticoagulation in all cases. We present a large, single-center experience with the AngioVac device. Our experience suggests a promising role for this device in the treatment of venous thromboembolism. This therapy can be safely performed with low complication rates and excellent technical results. Long-term follow-up and larger multicenter experience will further improve the understanding of this technology.