Technical implementation of percutaneous thrombus aspiration using the AngioVac system

Abstract

Objectives: The AngioVac system (AngioDynamics, Latham, NY, USA) provides a method for the minimally invasive, percutaneous aspiration of thrombus formations originating from the central venous system as well as solid matter such as lead vegetations and right atrial thrombi. Methods: This retrospective, observational study describes the initial experience in 52 adult patients with the AngioVac system, focusing mainly on the development of the extracorporeal circuit to improve usability and safety. Results: The mean patient age was 62.9 years (range 23-86 years). 22 patients were female and 30 were male. Indications for percutaneous aspiration were lead vegetations (n = 36; 69.2%), right atrial thrombi (n = 9; 17.3%), central venous thrombi (n = 5; 9.6%) and pulmonary embolisms (n = 2; 3.8%). Successful aspiration was performed in 44 cases (84.6%) and partial success was achieved in five patients (9.6%), while failure to remove thrombi or vegetations occurred in three cases (5.8%). Our practical experience led to the installation of a shunt line for recirculation and the implementation of safety features concerning air handling, which are also employed in minimally invasive extracorporeal bypass circuits. Initial tests monitored the level of negative pressure according to differences in flow and access sites but these still have to be validated on a larger scale. Conclusion: In this initial experience, the AngioVac system appeared to be safe regarding the extracorporeal circulation and the elimination of thrombi and lead vegetations.

Acute transvenous pacemaker lead thrombosis early after implantation: A rare clinical scenario

“…In case of thrombus attached to a pacemaker lead, the optimal therapy depends on clinical manifestation, size, and shape of the thrombus. A percutaneous aspiration device using a venous bypass circuit to aspirate thrombus or vegetations (AngioVac, AngioDynamics, Latham, New York, USA) is an alternative in this situation with a success rate of > 80% 32–34 . Additional data is needed to conclude which therapy is the best for a given clinical presentation.…”

“…A percutaneous aspiration device using a venous bypass circuit to aspirate thrombus or vegetations (AngioVac, AngioDynamics, Latham, New York, USA) is an alternative in this situation with a success rate of > 80%. [32][33][34] Additional data is needed to conclude which therapy is the best for a given clinical presentation. Since this is a rare manifestation, individualized treatment is still the preferred approach.…”

Percutaneous Thrombus Removal in a COVID-19–Infected Patient with Pulmonary Embolism

“…Thrombi in the vena cava and right atrium are risk factors for increased morbidity and mortality and are associated with the potential risk of PE. 3 In patients with PFO, these thrombi can get wedged in the PFO and also are associated with a high risk of cerebrovascular accidents. Percutaneous aspiration of thrombi or vegetations using the AngioVac system is a minimally invasive method that minimizes surgical trauma and associated comorbidities.…”

“…The SENTINEL cerebral protection system (SCPS, Boston Scientific) was deployed through a 6F sheath in the right radial artery (Figure 2 ), and the AngioVac system (Angiodynamics, Inc.) was deployed according to standard practice. 3 The right and left femoral veins were accessed using the modified Seldinger technique with a 19F Bio-Medicus (inflow) cannula (Medtronic), and a 25F sheath was used to accommodate the 25F Bio-Medicus (outflow) cannula. Cannulas were deployed over 0.035-inch Amplatz Super Stiff™ guidewires (Boston Scientific).…”

Removal of Wall-Adherent Inferior Vena Cava Thrombus with a Combined Approach Using Vacuum-Assisted Thrombectomy and a Rotational Thrombectomy Device

“…As described in detail by Haupt et al [ 5 ], the veno-venous extracorporeal circuit used at our institution for percutaneous aspiration procedures consists of the 22 F AngioVac (Gen 3) 20° suction cannula (AngioDynamics, Latham, NY, USA) for venous drainage, a CAPIOX® BT15 bubble trap (Terumo Cardiovascular, Ann Arbor, MI, USA) as a filter for aspirated thrombotic material, a centrifugal pump (Revolution 5, LivaNova, Mirandola, IT), and a 16 F Edwards Fem-Flex II cannula (Edwards Lifesciences, Irvine, CA, USA) for venous return. During the procedure, heparin is used for anticoagulation with a target-activated clotting time of 250 to 300 seconds.…”