Single Center Experience with the AngioVac Aspiration System

Abstract

AngioVac is a useful tool for acute thrombus removal in the large vessels. The setup and substantial cost may limit its application in straightforward cases. More studies are needed to establish the utility of AngioVac in treatment of intravascular and intracardiac material.

Non-surgical extraction of right atrial mass by AngioVac aspiration device under fluoroscopic and transesophageal echocardiographic guidance

“…In the largest AngioVac case series of 14 patients by Donaldson and colleagues, the thrombus was removed successfully in 73% of cases, and 87% of patients survived until the end of their hospitalization (2). Salsamendi and colleagues presented a case series of seven patients, all patients survived until the last follow-up visit (4). The AngioVac was effective in evacuation of thrombi at different sites, including iliocaval, IVC with renal vein extension, SVC, right atrium (RA), pulmonary arteries, Fontan circuit and Glenn shunt with pulmonary artery extension (4).…”

“…Salsamendi and colleagues presented a case series of seven patients, all patients survived until the last follow-up visit (4). The AngioVac was effective in evacuation of thrombi at different sites, including iliocaval, IVC with renal vein extension, SVC, right atrium (RA), pulmonary arteries, Fontan circuit and Glenn shunt with pulmonary artery extension (4). It also has been used to treat iliocaval thrombosis, secondary congenital thrombophilias, and secondary to IVC filters which was resistant to thrombolytics which indicates that AngioVac could potentially treat chronic venous thrombosis (5).…”

“…Despite fewer patients requiring blood transfusions, the common complications were a drop in hematocrit and hematomas at the site of access. There was no incidence of myocardial infarctions, strokes or pulmonary hemorrhages (2,4). Other theoretical potential complications include dissection or perforation of venous system, arrhythmia, embolization of clot or tumor fragments with subsequent cardiorespiratory compromise, damage to intracardiac structures (namely the tricuspid valve and right atrial wall rupture), air embolism, clot formation on AngioVac catheters, catheter malposition and unexpected decannulation (6).…”

“…Conventional aspiration devices (e.g., Greenfield embolectomy 10 French catheter) can remove occlusive thrombus by adjunctive maceration; however, their small caliber size and weak aspiration force limit their ability to remove solid masses larger than 1 cm (1). On the other hand, conventional therapy has significant peri-procedural risk, which precludes their use in some encounters (3,4). Thrombolytics have an overall bleeding risk of 22%, with up to 3% intracranial bleeding and risk of distal embolization of large mobile thrombi (2,3).…”

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

“…The AngioVac system has been described in several recent case reports (6,7) and single-institution case series (8)(9)(10). The purpose of this study is to describe a single-center experience with the AngioVac device in the management of large, central venous thromboembolism.…”