AngioVac Device Research Articles

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

PurposeTo describe initial single-center experience with a thrombectomy device in managing right atrial and caval thrombi, tumors, and vegetations. Materials and MethodsA 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. ResultsProcedural 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. ConclusionsAngioVac thrombectomy can be performed with high procedural success with clinical benefit in patients with right atrial and caval masses/thrombi.

Single-Center Experience Using AngioVac with Extracorporeal Bypass for Mechanical Thrombectomy of Atrial and Central Vein Thrombi

The AngioVac device (AngioDynamics, Inc, Queensbury, New York), a commercially available large-diameter aspiration cannula using extracorporeal venovenous bypass, is designed to facilitate en bloc mechanical thrombectomy of massive thrombi of the central vasculature. Between February 2014 and January 2015, seven consecutive patients, each presenting with large central thrombi of the iliac veins, vena cava, right atrium, or pulmonary artery, underwent thrombectomy. Partial or complete clot abatement was achieved in all instances. All patients survived the procedure. One case was complicated by embolization of septic thrombi. At most recent follow-up, one patient had died of causes unrelated to venous thrombosis; all other patients were living (median follow-up time 8 mo). Several technical and therapeutic insights were gained from our center’s early experience.

"Raking-in Technique:" Removal Of Brachiocephalic Vein Thrombus Using AngioVac® Device Within A Stented Venous Segment.

IntroductionA case is reported of left brachiocephalic vein thrombus removal using the Angiovac device within a stented venous segment via a through-and-through access technique.ReportThis novel technique involves obtaining through-and-through access from the left basilic vein to the right femoral vein, which then facilitates the advancement of the Angiovac device to successfully remove in a stepwise fashion the thrombus present within a stented region of the left brachiocephalic vein.DiscussionThe Angiovac device has been shown to be very useful and effective at removing large amounts of thrombus, tumor, and foreign bodies within arterial and venous systems successfully. This novel technique uses the through-and-through venous access approach to allow for this device to remain close to the targeted area of thrombus burden and prevent damage of the already existing stents in this region.

Percutaneous Vacuum-Assisted Thrombectomy Device Used for Removal of Large Vegetations on Infected Pacemaker and Defibrillator Leads as an Adjunct to Lead Extraction.

This case series reports our early experience with a minimally invasive percutaneous method of safely removing large vegetations during lead extraction in septic cardiac implantable electronic devices (CIED). Debate exists concerning the management of vegetations involving these devices. Lead extraction is mandated for infections, but vegetations may embolize, causing complications. Surgical debridement is recommended; alternatives include cardiopulmonary bypass, minimally invasive thoracotomy, or transatrial approaches. The AngioVac device allows percutaneous right heart bypass and suction removal of vegetations under echocardiographic and fluoroscopic guidance. This case series describes our first 20 patients, all critically ill with persistent sepsis and vegetations despite long-term antibiotics. This series includes patients who would not have been eligible for alternative procedures due to contraindications and highlights the potential role of this new technology.

Venous Thromboembolic Disease: The Use of the Aspiration Thrombectomy Device AngioVac.

Central venous thrombosis is a complex problem, particularly in cases where the thrombus burden is large. Several interventional techniques and devices have been developed over the past 15 to 20 years to manage this entity, but the vast majority of them still need the concomitant use of thrombolytics to achieve an optimal result. AngioVac (AngioDynamics, Latham, NY) is the first aspiration thrombectomy device capable to remove a larger burden of undesired intravascular material such as thrombus, tumor, and foreign bodies without the need of lytics. This review focuses on the AngioVac device in the management of iliocaval thrombosis and pulmonary embolism.

Percutaneous Removal of Filter-Induced Iliocaval Thrombus Using the AngioVac Device

Percutaneous Removal of Filter-Induced Iliocaval Thrombus Using the AngioVac Device

5:36 PM, Abstract No. 160 - Bulk removal of caval and right atrial thrombi and masses using the novel AngioVac device: initial operative experience, patient demographics and outcomes

5:36 PM, Abstract No. 160 - Bulk removal of caval and right atrial thrombi and masses using the novel AngioVac device: initial operative experience, patient demographics and outcomes

Percutaneous Thrombectomy with the AngioVac Aspiration Device: a Single-Center Experience

Purpose To describe a single-center experience with the AngioVac device (Angiodynamics, Latham, New York), a 22 Fr percutaneous aspiration thrombectomy device designed for venous aspiration, extra-corporeal filtration, and venous re-infusion. Material and Methods Institutional Review Board exemption was obtained for retrospective analysis of the medical records from 13 consecutive cases using the AngioVac device 1 January 2012 through 1 September 2014. Results Mean patient age was 49 years (range 24 to 71 years). Nine patients had thrombus located in the inferior vena cava (IVC), 3 in the right heart, and 1 in the pulmonary artery. Cardiothoracic or peripheral vascular surgical services evaluated the patients and deemed them ineligible for surgery. Nine cases were clinically and angiographically successful. No adjunctive therapy, such as venous stent placement, was required. One patient experienced hyperkalemic cardiac arrest after successful thrombectomy and survived after 5 minutes of advanced cardiovascular life support. Four cases were unsuccessful. One patient with enlarging high volume pulmonary embolism (PE) and right atrial mass, later found to be a tumor thrombus, died due to iatrogenic PE, and 1 patient with pulmonary artery thrombus experienced acute cardiogenic shock after her tricuspid valve was damaged by the advancing cannula. The patient survived open tricuspid valve repair and pulmonary artery thrombectomy. One case was abandoned prior to thrombectomy because sufficient bypass flow could not be established, and 1 case was abandoned after the cleared IVC immediately re-occluded with thrombus. Conclusions In our experience, aspiration thrombectomy using the AngioVac device is safe and effective in removing central caval thromboses. The use of the AngioVac device to remove thrombus in the right heart is effective but may carry a higher risk of severe complication. Pulmonary artery thrombectomy is the most challenging because of the complexity of advancing the cannula through the heart and the high likelihood of an unstable patient.

Vacuum-Assisted Thrombectomy Device (AngioVac) in the Management of Symptomatic Iliocaval Thrombosis

Three patients with complete iliocaval thrombosis causing symptomatic leg swelling failed initial treatment with standard pharmacomechanical techniques. The occluded segments of the inferior vena cava and iliac veins were subsequently treated with the AngioVac Cannula (AngioDynamics, Latham, New York) and extracorporeal venous bypass circuit. In each patient, symptoms improved after treatment. This report discusses potential benefits and ancillary techniques of using the AngioVac device for iliocaval venous thrombosis.

Endovascular treatment of a thrombosed intracardiac vena cava filter.

Intracardiac migration of a vena cava filter (VCF) is a rare but potentially fatal complication. We describe a unique case of intracardiac migration of a permanent VCF with extensive thrombus propagating into the inferior vena cava and right atrium. Percutaneous thrombectomy with the AngioVac (AngioDynamics, Latham, NY) device was performed, and the permanent VCF was percutaneously removed.

Hybrid Minimally Invasive Extraction of Atrial Clot Avoids Redo Sternotomy in Jehovah's Witness

We report the novel use of the AngioVac device in a percutaneous hybrid approach to remove a large right atrial clot as an effective and potentially lifesaving alternative to a very high-risk redo-sternotomy in a Jehovah's Witness patient.

Foreword

To investigate the utility of AngioVac-assisted vegetation debulking (AVD) in right sided infective endocarditis (RSIE). AngioVac is a vacuum-based device that was approved in 2014 for the percutaneous removal of undesirable materials from the intravascular system. Although there are multiple reports on the use of the AngioVac device to aspirate right-sided heart chamber thrombi, data on its use to treat RSIE is limited. We performed a comprehensive literature search for studies that evaluated the utility of AVD. The primary outcomes of our study were the procedural success, defined as the ability of AngioVac to produce residual vegetation size <50% (RVS<50%) without serious procedural complications, and the clinical success, defined as composite of RVS<50%, in-hospital survival, absence of recurrent bacteremia, and valve function not requiring further intervention. The secondary outcomes included the individual components of the primary outcomes and average length of hospital stay. The pooled means and proportions of our data were analyzed using random effects model, generic inverse variance method, and represented with 95% confidence intervals (CIs). A total of 44 studies, including 301 patients (mean age: 44.6 ± 18.2 years, 71.6% males) were included. Procedural success was achieved in 89.2% of patients (95% CI:82.3%-93.6%, I2 = 0%). Clinical success was achieved in 79.1% of patients (95% CI:67.9%-87.2%, I2 = 15%). Overall survival rate was 89.7% (95% CI:83.1%-93.9%%, I2 = 9%). Our meta-analysis demonstrates that AVD is a promising therapeutic option for RSIE offering a high success rate with an acceptable complication rate across a wide range of patients.