1
|
Khandait H, Hanif M, Ramadan A, Attia AM, Endurance E, Siddiq A, Iqbal U, Song D, Chaudhuri D. A meta-analysis of outcomes of aspiration thrombectomy for high and intermediate-risk pulmonary embolism. Curr Probl Cardiol 2024; 49:102420. [PMID: 38290623 DOI: 10.1016/j.cpcardiol.2024.102420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Aspiration thrombectomy has gained popularity in patients with massive and sub-massive pulmonary embolism (PE) and having contraindications to thrombolysis. METHODS A meta-analysis was conducted including studies on aspiration thrombectomy in patients with high-risk and intermediate-risk PE. The pooled odds ratio for efficacy parameters, including change in heart rate, blood pressure and right ventricle/left ventricle (RV/LV) ratio, and safety parameters including major bleeding and stroke, was calculated using a random effects model. RESULTS The meta-analysis of 24 selected studies revealed that intermediate and high-risk pulmonary embolism (PE) patients demonstrated significant improvements: modified Miller score odds ratio of 10.60, mean pulmonary artery pressure reduction by 0.04 mm Hg, and an overall all-cause mortality odds ratio of 0.10. Considerable heterogeneity was observed in various outcomes. CONCLUSION Aspiration thrombectomy has success rates in both high-risk and intermediate-risk PE, however, procedural risks, including bleeding, must be anticipated.
Collapse
Affiliation(s)
| | - Muhammad Hanif
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Alaa Ramadan
- Faculty of Medicine, South Valley University, Qena, Egypt
| | | | | | | | - Unzela Iqbal
- Trinitas Regional Medical Center/RWJ Barnabas Health, NJ, USA
| | - David Song
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai Elmhurst Hospital Center, Queens NY, USA
| | - Debanik Chaudhuri
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| |
Collapse
|
2
|
Bansal N, Younes S, Maaieh M. Percutaneous Debulking of a Large Mobile Mitral Valve Vegetation Using the Angiovac. Cureus 2024; 16:e56537. [PMID: 38646334 PMCID: PMC11027443 DOI: 10.7759/cureus.56537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
The Angiovac aspiration system has been used successfully for the removal of intravascular material or thrombus in the right-sided heart structures, vena cava, implantable cardiac defibrillator, or other devices. For infective endocarditis, it is reserved for the patients who warrant but are not good candidates for the surgery. The evidence regarding Angiovac aspiration of the infective endocarditis of the left-sided heart valves is scarce. The risk of complications, including thrombi fragmentation leading to systemic embolization, damage to the cardiac structures and tissue, and hemodynamic instability, precludes the widespread use of this procedure, especially for the left-sided lesions. We report a case of successful removal of the mitral valve endocarditis using the Angiovac aspiration technique under the TEE guidance. A SENTINEL™ cerebral protection system was used to prevent embolus migration and a venous rather than an arterial access was used for reperfusion.
Collapse
Affiliation(s)
- Nahush Bansal
- Department of Internal Medicine, The University of Toledo, Toledo, USA
| | - Stephanie Younes
- Department of Cardiology, ProMedica Toledo Hospital, Toledo, USA
| | - Mohammed Maaieh
- Department of Cardiology, ProMedica Toledo Hospital, Toledo, USA
| |
Collapse
|
3
|
Tarzia V, Ponzoni M, Tessari C, Evangelista G, Zanella F, Pittarello D, Gerosa G. Navigating the Heart. The Evolution of the AngioVac System in a Single-center Experience. Curr Probl Cardiol 2023; 48:101543. [PMID: 36529227 DOI: 10.1016/j.cpcardiol.2022.101543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
We investigated the efficacy, safety, and versatility of the AngioVac (AngioDynamics, Latham, NY) system for the treatment of intravascular and intracardiac masses of different origins. We prospectively enrolled all consecutive patients treated with the AngioVac system between July-2016 and November-2021 at our institution. Three configurations of the device were adopted in 44 patients: a venous-venous circuit in 21 cases (47.7%), a venous-arterial ECMO-like configuration in 20 (45.5%), and a venous-arterial-arterial circuit with 2 centrifugal pumps for left-sided cardiac masses in 3 (6.8%). Successful removal of the mass was achieved in 41 patients (93.2%), while in the other cases conversion to full sternotomy was necessary. Intraoperative complications occurred in 3 cases (6.8%), including 1 death, 1 pulmonary embolization, and 1 cardiac perforation. The AngioVac system is a valid, safe, and versatile option for the treatment of intravascular masses also in patients with prohibitive surgical risk.
Collapse
Affiliation(s)
- Vincenzo Tarzia
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy.
| | - Matteo Ponzoni
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Chiara Tessari
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Evangelista
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Fabio Zanella
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Demetrio Pittarello
- Anesthesia and Intensive Care Unit, University of Padua, Padua, Italy; From the Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, University of Padua, Padua, Italy
| |
Collapse
|
4
|
Muacevic A, Adler JR. Submassive Pulmonary Embolism in the Setting of Intracerebral Hemorrhage: A Case of Suction Thrombectomy. Cureus 2022; 14:e32432. [PMID: 36644103 PMCID: PMC9833621 DOI: 10.7759/cureus.32432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 12/14/2022] Open
Abstract
Pulmonary embolism (PE) in the setting of intracerebral hemorrhage (ICH) is an unfortunate, challenging, and highly morbid clinical problem. Interventional strategies have lower associated bleeding risks than the standby for PE treatment: systemic anticoagulation. Despite this benefit, there are few examples in the literature of its utilization in the management of PE in the setting of ICH. This present case provides an example of the successful utilization of suction thrombectomy to manage PE in the setting of ICH. An 80-year-old female presented to an outside hospital with complaints of dizziness, headache, nausea, and vomiting of abrupt onset one hour before arrival. Computed tomography (CT) of the head with CT Angiography (CTA) of the head and neck was performed and demonstrated hemorrhage in all ventricles; most prominently within the left lateral ventricle. Magnetic Resonance Imaging (MRI) of the brain suggested that the cause of her hemorrhage was reperfusion injury after a small acute infarction in the left internal capsule in the setting of anticoagulant use. Ten days after her diagnosis of ICH, a submassive PE was diagnosed with a class IV pulmonary embolism severity index (PESI). An interdisciplinary evaluation was conducted between hospitalist medicine, neurology, neurosurgery, and interventional radiology. A successful suction thrombectomy was performed on hospital day 11. No new neurologic deficits were appreciated post-procedure. The patient's heart rate remained elevated but improved. Blood pressure remained controlled. The patient was weaned off oxygen to room air. Neurosurgery assessed the patient to be of acceptable risk for discharge with the further deferment of anticoagulation until repeat CT head six weeks after discharge. The patient was discharged on hospital day 14. Treating PE in the setting of ICH is without clear guidelines. The appropriate treatment modality is reliant upon the clinical judgment and the individual details of each case. In this case, a high PESI with imaging demonstrating a stable hematoma without evidence of new blood resulted in the decision to use a suction thrombectomy. More research is needed to develop consistent evidence-based guidelines for this clinical challenge.
Collapse
|
5
|
Mathevosian S, Ranade M. Right Heart Clot-in-Transit: Endovascular Therapies. Semin Intervent Radiol 2022; 39:515-522. [PMID: 36561934 PMCID: PMC9767789 DOI: 10.1055/s-0042-1757942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Right heart thrombus is a challenging high mortality disease typically seen in the setting of pulmonary embolism. Traditional treatments have included anticoagulation, thrombolysis, and surgical embolectomy. Advances in recognition and treatment of clot-in-transit have led to the development of endovascular therapies increasingly becoming the preferred method of treatment due to rapid debulking and lower morbidity. Novel endovascular devices are large bore aspiration thrombectomy systems which mitigate the use of concomitant thrombolytics. The article reviews the disease process, relevant literature, and current endovascular devices and strategies for the treatment of right heart thrombus and clot-in-transit.
Collapse
Affiliation(s)
- Sipan Mathevosian
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Mona Ranade
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| |
Collapse
|
6
|
Qintar M, Wang DD, Lee J, Villablanca P, Eng MH, Frisoli T, O'Neill BP, O'Neill WW. Transcatheter vacuum-assisted left-sided mass extraction with the AngioVac system. Catheter Cardiovasc Interv 2022; 100:628-635. [PMID: 35900207 DOI: 10.1002/ccd.30345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/16/2022] [Accepted: 07/02/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To study the safety and efficacy of AngioVac for left-sided transcatheter vacuum-assisted mass extraction (TVME). BACKGROUND The AngioVac system is approved for right-sided TVME and has emerged as an effective and safe alternative for open surgical treatment. The use of the AngioVac device for aspiration of left-sided TVME has been limited. METHODS Consecutive patients from two Michigan centers who underwent left-sided TVME were included. Data on patient demographics, procedural information, in-hospital and follow-up events were collected through electronic medical records review. Technical success was defined as aspirating of 70%-100% of the material. RESULTS Ten patients (mean age 58.3 [±17.3] years, 50% male) were included. Indications for TMVE were in large for recurrent embolic events. All patients underwent bilateral cerebro-embolic protection using the Sentinel device. The total mean procedure time was 192.5 (±47.5) min of which the meantime for active aspiration (bypass time) was 9.3 (±4.2) min. The circuit configuration was: arteriovenous (AV) in four cases and arterioarterial (AA) in six cases. Successful aspiration was achieved in 80% of cases. No complications were reported (range follow-up 1-16 months). CONCLUSIONS Our small case series demonstrates the feasibility and safety of the AngioVac system in left-sided mass extraction. Larger trials are needed to further demonstrate its effectiveness and safety and potentially apply for on-label use.
Collapse
Affiliation(s)
- Mohammed Qintar
- Division of Cardiology, Sparrow Hospital and College of Human Medicine, Michigan State University, Lansing, Michigan, USA.,Division of Cardiology, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Dee D Wang
- Division of Cardiology, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - James Lee
- Division of Cardiology, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Pedro Villablanca
- Division of Cardiology, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Marvin H Eng
- Division of Cardiology, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Tiberio Frisoli
- Division of Cardiology, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - Brian P O'Neill
- Division of Cardiology, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - William W O'Neill
- Division of Cardiology, Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| |
Collapse
|
7
|
Continuous Aspiration Mechanical Thrombectomy for the management of intermediate- and high-risk pulmonary embolism: Data from the first cohort in Portugal. Rev Port Cardiol 2022; 41:533-545. [DOI: 10.1016/j.repc.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 03/19/2021] [Accepted: 04/07/2021] [Indexed: 12/17/2022] Open
|
8
|
Moriarty JM, Liao M, Kim GHJ, Yang E, Desai K, Ranade M, Plotnik AN. Procedural outcomes associated with use of the AngioVac System for right heart thrombi: A safety report from RAPID registry data. Vasc Med 2022; 27:277-282. [PMID: 35176918 DOI: 10.1177/1358863x211073974] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Right heart thrombi can be a source of considerable morbidity and mortality, especially when associated with pulmonary embolism. Methods: To understand the safety and procedural efficacy associated with vacuum-assisted thrombectomy using the AngioVac System (AngioDynamics, Latham, NY, USA) to remove right heart thrombi, we conducted a subanalysis of the Registry of AngioVac Procedures in Detail (RAPID) multicenter registry representing 47 (20.1%) of 234 participants in the registry. Forty-two (89.4%) patients had thrombi located in the right atrium alone, three (6.4%) in the right ventricle alone, and two (4.3%) in both the right atrium and ventricle. Four (8.5%) patients had concomitant caval thrombi, three (6.4%) also had catheter-related thrombi, and one (2.1%) patient had both caval and catheter-related thrombi with their right heart thrombi. Results: Extracorporeal bypass time was less than 1 hour for 39 (83.0%) procedures. Seventy to 100% removal of thrombus was achieved in 59.6% of patients. Estimated blood loss was less than 250 cc for 43 procedures (91.6%). Mean hemoglobin decreased from 10.7 ± 2.2 g/dL preoperatively to 9.6 ± 1.6 g/dL postoperatively. Transfusions were administered for eight procedures (17.0%), with only one (2.1%) patient receiving more than 2 units of blood. Six patients (12.8%) experienced procedure-related adverse events, including three (6.4%) patients who experienced distal emboli and three (6.4%) patients who developed bleeding-related complications. All adverse events resolved prior to discharge. There was one death (2.1%) reported that was not procedure related. Conclusion: Vacuum-assisted thrombectomy can be performed safely in patients with right heart thrombi. ClinicalTrials.gov Identifier: NCT04414332.
Collapse
Affiliation(s)
- John M Moriarty
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Millie Liao
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Grace Hyun J Kim
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Medicine, Division of Cardiology, UCLA Medical Center, Los Angeles, CA, USA
| | - Eric Yang
- Department of Medicine, Division of Cardiology, UCLA Medical Center, Los Angeles, CA, USA
| | - Kush Desai
- Department of Radiology, Division of Interventional Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mona Ranade
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Adam N Plotnik
- Department of Radiology, Division of Interventional Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| |
Collapse
|
9
|
Enezate T, Alkhatib D, Raja J, Chinta V, Patel M, Omran J. AngioVac for Minimally Invasive Removal of Intravascular and Intracardiac Masses: a Systematic Review. Curr Cardiol Rep 2022; 24:377-382. [PMID: 35129741 DOI: 10.1007/s11886-022-01658-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Management of intracardiac masses, such as right heart thrombi and catheter-related vegetations, can be challenging. Many patients are high-risk candidates for surgical extraction due to multiple comorbidities and risk of distal embolization. In this review, we highlight the advancements in percutaneous approaches for treatment of intracardiac masses utilizing AngioVac (AngioDynamic, Latham, NY). RECENT FINDINGS With the Food and Drug Administration (FDA) approval of the AngioVac System in 2009, a growing body of evidence has proven it to be a feasible and effective tool to extract thrombi and masses from the iliocaval system and the right heart. In this review, we highlight the feasibility of AngioVac System (AngioDynamic, Latham, NY) based on the published cases series and registries. Future randomized controlled trials are needed to establish an algorithmic approach in treating intracardiac masses.
Collapse
Affiliation(s)
- Tariq Enezate
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA.,Division of Cardiovascular Diseases, Memphis Veterans Affairs Medical Center, Memphis, TN, USA
| | - Deya Alkhatib
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joel Raja
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Viswanatha Chinta
- Division of Cardiovascular Diseases, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Mitul Patel
- Sulpizio Cardiovascular Center, University of California San Diego, San Diego, CA, USA
| | - Jad Omran
- Sharp HealthCare System, 5555 Grossmont Center Dr. La Mesa, San Diego, CA, 91942, USA.
| |
Collapse
|
10
|
Endovascular Treatment of Right Heart Masses Utilizing the AngioVac System: A 6-Year Single-Center Observational Study. J Interv Cardiol 2021; 2021:9923440. [PMID: 34803526 PMCID: PMC8572623 DOI: 10.1155/2021/9923440] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/27/2021] [Accepted: 10/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To describe our institution's experience with the AngioVac system. Background Intracardiac and intravascular masses previously required surgical excision, but now, there are a number of minimally invasive options. With the advent of vacuum aspiration, more specifically the AngioVac System (AngioDynamics, NY, USA), there exists a system with both low mortality and minor complications. However, the number of retrospective studies remains limited. Outcome data for high-risk patients are also limited. Methods Data were collected and analyzed in patients who underwent AngioVac therapy at our tertiary care center from January 2014 to December 2020. Results Our results demonstrated a 93.3% intraoperative success rate and a 100% intraoperative survival rate. However, a number of complications, including but not limited to hematomas, anemia, and hypotension, occurred, as described below. Conclusions Our experiences demonstrated good outcomes and continue to support the usefulness of the AngioVac System. The data also support the use of AngioVac as a treatment option for the debulking or removal of right heart masses in critically ill patients.
Collapse
|
11
|
Yu T, Yang EH, Ranade M. AngioVac aspiration of right atrial cardiac pacemaker lead-associated thrombus with concurrent PE under fluoroscopic and transesophageal echocardiographic guidance: a multidisciplinary collaboration for improved patient outcome. Clin Imaging 2021; 81:33-36. [PMID: 34598001 DOI: 10.1016/j.clinimag.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/21/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
In the U.S., pulmonary embolism (PE) is a common cause of cardiovascular death. Right heart thrombus (RHT) occurs in approximately 4% of patients with PE, and when concurrent is associated with increased 30-day PE-related and all-cause mortality. The consensus on optimal management of acute massive or high-risk PE is unclear, and even less so for concurrent RHT. In this report, we review a successful multidisciplinary coordination of vacuum-assisted thrombectomy (VAT) of a complex pacemaker lead-associated RHT in a patient with concurrent acute PE and significant comorbidities, using the AngioVac system (Vortex Medical, Norwell, MA). VAT is a reasonable treatment option that should be considered particularly for patients who are poor surgical or thrombolytic candidates. Procedural success and patient outcomes can be further optimized through multidisciplinary collaboration such as with the Pulmonary Embolism Response Team (PERT) model.
Collapse
Affiliation(s)
- Tiffany Yu
- Department of Radiological Sciences, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America.
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America.
| | - Mona Ranade
- Department of Radiological Sciences, University of California at Los Angeles, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America.
| |
Collapse
|
12
|
Kang J, Fleischman F, Saremi F, Shavelle DM. En Bloc AngioVac Removal of Thoracic Aortic Mass. Tex Heart Inst J 2021; 47:315-318. [PMID: 33472232 DOI: 10.14503/thij-18-6917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The AngioVac system, designed for suction during extracorporeal bypass, is used to aspirate masses, thrombi, and other undesirable material from the cardiovascular system. To date, it has been used extensively in the venous system and right side of the heart; however, its use in the arterial system has been limited because of smaller vessel sizes and the requirement for a 26F sheath. We report the case of a 45-year-old woman with a history of angiosarcoma who presented with acute embolic events that affected her spleen and lower extremities. We removed a large mobile mass en bloc from her distal thoracic aorta by using the AngioVac system as an alternative to surgical resection. The patient recovered with no recurrence. We discuss the benefits and challenges of using the AngioVac within small vessels of the arterial system.
Collapse
Affiliation(s)
- Jeanney Kang
- Department of Internal Medicine, University of Southern California, Los Angeles, California 90033
| | - Fernando Fleischman
- Division of Cardiothoracic Surgery, University of Southern California, Los Angeles, California 90033
| | - Farhood Saremi
- Department of Radiology, University of Southern California, Los Angeles, California 90033
| | - David M Shavelle
- MemorialCare Heart & Vascular Institute, Long Beach Medical Center, Long Beach, California 90806
| |
Collapse
|
13
|
Callese TE, O'Brien DP, Wilhalme H, Yang EH, Moriarty JM. AngioVac Aspiration Thrombectomy of Right Atrial Thrombus is Safe and Effective in Cancer Patients. Ann Vasc Surg 2021; 77:243-254. [PMID: 34437971 DOI: 10.1016/j.avsg.2021.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 05/16/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that endovascular aspiration thrombectomy of right atrial thrombus (RAT) using the AngioVac device is as safe and effective in patients with cancer as those without cancer. BACKGROUND RAT is a uniquely challenging clinical presentation of venous thromboembolism due to its low incidence and historically high-risk of mortality due to thrombus propagation into the pulmonary arteries. There is a lack of consensus regarding management, particularly in high-risk cancer patients. Endovascular aspiration thrombectomy utilizing the AngioVac device is effective in removal of right atrial thrombus and may be a safer option for patients with cancer in whom avoidance of higher-risk intervention is preferred. METHODS This was an institutional review board-approved retrospective single-center case control study of patients with RAT who underwent AngioVac aspiration thrombectomy between August 2013 and July 2020. Analysis of patient demographics and clinical characteristics, thrombus-related factors, and operative details was performed. Primary endpoints included survival, safety, and technical success. RESULTS A total of 44 patients met inclusion criteria, 20 of whom with active malignancy. The oncology group had a significantly higher Charlson comorbidity index (P = 0.01). Comparative outcomes between the oncology and non-oncology group showed no difference in survival (P = 0.8) or technical success (OR 3, 95% CI 0.83-10.9). There were 9 complications, including 6 minor, 1 moderate, 1 severe, and 1 death. CONCLUSIONS AngioVac aspiration thrombectomy of RAT is as safe and effective in patients with cancer as those without cancer.
Collapse
Affiliation(s)
- Tyler E Callese
- Department of Radiology, Division of Interventional Radiology, University of California at Los Angeles, Los Angeles, CA.
| | - Daniel P O'Brien
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Holly Wilhalme
- Department of Medicine, Division of General Internal Medicine and Health Services Research, Los Angeles, CA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - John M Moriarty
- Department of Radiology, Division of Interventional Radiology, University of California at Los Angeles, Los Angeles, CA
| |
Collapse
|
14
|
Successful IVC thrombus extraction with the AngioVac device following five vessel coronary artery bypass graft: a case report. J Cardiothorac Surg 2021; 16:226. [PMID: 34372883 PMCID: PMC8350305 DOI: 10.1186/s13019-021-01605-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/29/2021] [Indexed: 11/14/2022] Open
Abstract
Background Inferior vena cava thrombosis is cited to be a complication of inferior vena cava filter placement and post coronary artery bypass surgery. Often only mild symptoms arise from these thrombi; however, due to the chronic nature of some thrombi and the recanalization process, more serious complications can arise. Although anticoagulation remains the gold standard of treatment, some patients are unable to be anticoagulated. In this case, we present a 65-year-old male who underwent IVC filter placement and open-heart surgery who later developed extensive femoral and iliocaval thrombosis leading to right heart failure, which required thrombus extraction with an AngioVac suction device. Case presentation We present a 65-year-old male who presented with bilateral pulmonary emboli with extensive right lower extremity deep vein thrombosis. Upon investigation he had ischemic heart disease and underwent a five-vessel coronary artery bypass for which he had an IVC filter placed preoperatively. On post operative day 3 to 4, he was decompensated and was diagnosed with an IVC thrombus. He progressed to right heart failure and worsening cardiogenic shock despite therapeutic anticoagulation and was taken for a suction thrombectomy using the AngioVac (AngioDynamics, Latham, NY) aspiration thrombectomy device. The thrombectomy was successful and he was able to recover and was discharged from the hospital. Conclusion Despite being a rare complication, IVC thrombosis can have detrimental effects. This case is an example of how IVC thrombus in the post-operative setting can lead to mortality. The gold standard is therapeutic anticoagulation but despite that, this patient continued to have worsening cardiogenic shock. Other therapies have been described but because of its rarity, they are only described in case reports. This case shows that the AngioVac device is a successful treatment option for IVC thrombus and can have the possibility of future use.
Collapse
|
15
|
Reddy PKV, Kwan T, Latouff O, Patel A. Suction thrombectomy of a massive, hypermobile (type C) right atrial thrombus: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab122. [PMID: 34124551 PMCID: PMC8188869 DOI: 10.1093/ehjcr/ytab122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/23/2020] [Accepted: 03/15/2021] [Indexed: 11/23/2022]
Abstract
Background Right atrial thrombus (RAT) may be managed according to morphology and aetiology, i.e. Type A thrombi (‘clot-in-transit’, hypermobile) are managed with thrombolytics and surgical embolectomy due to high risk of embolization; Type B thrombi (broad-based, globular) may be managed medically as they will very likely maintain a benign course. Experience with management of a Type C thrombus (hypermobile but also broad-based) has not been explicitly described in the literature. Case summary A 25-year-old man with history of leukaemia with prior right subclavian vein chemoport is found to have massive RAT. Multimodal imaging shows a hypermobile mass attached to the right atrial lateral wall inferior to superior vena cava and prolapsing into right ventricle in diastole. Given the thrombus morphology and likely propagation from subclavian port, risk of catastrophic embolization was deemed high and as such, intervention was indicated. Systemic anticoagulation was considered but deferred due to theoretical risk of dissolving the thrombus stalk leading to embolization. Surgical thrombectomy was offered but the patient declined. Due to evidence for success in RAT, the AngioVac System: Generation 3 (Angiodynamics, Inc., Latham, NY, USA) was chosen for intervention. The RAT was successfully removed without any complication. Discussion AngioVac suction thrombectomy is a safe alternative option for removal of a Type C, massive, hypermobile RAT.
Collapse
Affiliation(s)
- Pavan K V Reddy
- Division of Cardiovascular Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside, 1111 Amsterdam Ave., New York, NY 10031, USA
| | - Tak Kwan
- Division of Cardiovascular Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside, 1111 Amsterdam Ave., New York, NY 10031, USA
| | - Omar Latouff
- Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside, New York, NY, USA
| | - Apurva Patel
- Division of Cardiovascular Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside, 1111 Amsterdam Ave., New York, NY 10031, USA
| |
Collapse
|
16
|
Structural Transcatheter Cardiac Interventions in the Cardio-Oncology Population. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00898-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
17
|
Moriarty JM, Rueda V, Liao M, Kim GHJ, Rochon PJ, Zayed MA, Lasorda D, Golowa YS, Shavelle DM, Dexter DJ. 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.e3. [PMID: 33526346 DOI: 10.1016/j.jvir.2020.09.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To assess device and procedural safety and technical success associated with the use of the AngioVac System to remove vascular thrombi and cardiac masses. MATERIALS AND METHODS The Registry of AngioVac Procedures in Detail (RAPID) study prospectively collected data for 234 patients receiving treatment with AngioVac at 21 sites between March 2016 and August 2019: 84 (35.9%) with caval thromboemboli (CTEs), 113 (48.3%) with right heart masses (RHMs), 20 (8.5%) with catheter-related thrombi (CRTs), and 4 (1.7%) with pulmonary emboli (PEs). Thirteen patients had a combination of procedures during the same admission. RESULTS Using the AngioVac system, 70%-100% thrombus or mass removal was achieved in 73.6% of patients with CTEs, 58.5% of patients with RHMs, 60% of patients with CRTs, and 57.1% of patients with PEs. Extracorporeal bypass time was < 1 hour for 176 (75.2%) procedures. Estimated blood loss was < 250 mL for 179 procedures (76.5%). Mean hemoglobin decreased from 10.4 g/dL ± 2.9 preoperatively to 9.4 g/dL ± 2.6 postoperatively. Transfusions were administered in 59 procedures (25.2%) with 47 transfusions (78.2%) being ≤ 2 U. There were 36 procedure-related complications, including 1 death. CONCLUSIONS The RAPID registry data demonstrate that the AngioVac System can be safely and effectively used to remove vascular thrombi and cardiac masses across a broad range of patient populations. The limited use of the device to remove pulmonary emboli in the present series precludes recommending the use of the AngioVac device for this indication.
Collapse
Affiliation(s)
- John M Moriarty
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Victoria Rueda
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Millie Liao
- Loma Linda University School of Medicine, Loma Linda, California
| | - Grace Hyun J Kim
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Paul J Rochon
- Division of Interventional Radiology, Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Mohamed A Zayed
- Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - David Lasorda
- Department of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Yosef S Golowa
- Department of Vascular and Interventional Radiology, Montefiore Medical Center, New York, New York
| | - David M Shavelle
- Division of Cardiovascular Medicine, Keck School of Medicine at USC, Los Angeles, California
| | - David J Dexter
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Virginia
| |
Collapse
|
18
|
Anfinogenova ND, Vasiltseva OY, Vrublevsky AV, Vorozhtsova IN, Popov SV, Smorgon AV, Mochula OV, Ussov WY. Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review. Semin Thromb Hemost 2020; 46:895-907. [PMID: 33368111 DOI: 10.1055/s-0040-1718399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Prompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.
Collapse
Affiliation(s)
- Nina D Anfinogenova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Oksana Y Vasiltseva
- Unit of Aorta and Coronary Artery Surgery, E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russia
| | - Alexander V Vrublevsky
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Irina N Vorozhtsova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Sergey V Popov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Andrey V Smorgon
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Olga V Mochula
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Wladimir Y Ussov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| |
Collapse
|
19
|
Green EA, Pollema T, Pretorius V. A Case of CIED-Associated Endocarditis and Septic Emboli Requiring Lead Extraction, AngioVac Suction, and Pulmonary Endarterectomy. Cureus 2020; 12:e11601. [PMID: 33364121 PMCID: PMC7752741 DOI: 10.7759/cureus.11601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Cardiac Implantable Electronic Devices (CIED)-associated infective endocarditis complicated by septic emboli and acute on chronic pulmonary hypertension is rare. We present a case where pulmonary thromboendarterectomy was required for treatment. A 55 year-old man with a history of myocardial infarction and ischemic cardiomyopathy status-post ICD placement 8 years prior presented with bacteremia, infected ICD, and tricuspid valve vegetation. He underwent CIED extraction along with the use of the AngioVac suction device to remove right ventricular and atrial vegetations. However the patient had persistent valvular vegetation and bilateral sub-massive pulmonary emboli. Pulmonary angiography showed filling defects in the lobar and segmental arteries. Percutaneous attempts at embolectomy were unsuccessful and he therefore underwent a pulmonary endarterectomy surgery (PTE). This case of CIED- associated endocarditis demonstrates the importance of early aggressive treatment of such infections. Guidelines recommend compete CIED system removal when there is associated infection. The AngioVac is a novel system for removal of right-sided vegetations and thrombi; however, complications such as distal embolization can occur. PTE surgery for septic emboli is rare. However, cases of such treatment as is presented here can be successful and may be necessary should percutaneous methods fail.
Collapse
Affiliation(s)
- Erik A Green
- Surgery, Tulane University School of Medicine, New Orleans, USA
| | - Travis Pollema
- Cardiothoracic Surgery, University of California San Diego School of Medicine, La Jolla, USA
| | - Victor Pretorius
- Cardiothoracic Surgery, University of California San Diego School of Medicine, La Jolla, USA
| |
Collapse
|
20
|
Abstract
Purpose of the Review Over 100,000 cardiovascular-related deaths annually are caused by acute pulmonary embolism (PE). While anticoagulation has historically been the foundation for treatment of PE, this review highlights the recent rapid expansion in the interventional strategies for this condition. Recent Findings At the time of diagnosis, appropriate risk stratification helps to accurately identify patients who may be candidates for advanced therapeutic interventions. While systemic thrombolytics (ST) is the mostly commonly utilized intervention for high-risk PE, the risk profile of ST for intermediate-risk PE limits its use. Assessment of an individualized patient risk profile, often via a multidisciplinary pulmonary response team (PERT) model, there are various interventional strategies to consider for PE management. Novel therapeutic options include catheter-directed thrombolysis, catheter-based embolectomy, or mechanical circulatory support for certain high-risk PE patients. Current data has established safety and efficacy for catheter-based treatment of PE based on surrogate outcome measures. However, there is limited long-term data or prospective comparisons between treatment modalities and ST. While PE diagnosis has improved with modern cross-sectional imaging, there is interest in improved diagnostic models for PE that incorporate artificial intelligence and machine learning techniques. Summary In patients with acute pulmonary embolism, after appropriate risk stratification, some intermediate and high-risk patients should be considered for interventional-based treatment for PE.
Collapse
|
21
|
Lu SY, Dalia AA, Lang M, Fitzsimons MG. Perioperative Outcomes of Thrombectomy Patients Using Venovenous Bypass and Suction Filtration With General Anesthesia. J Cardiothorac Vasc Anesth 2020; 35:1040-1045. [PMID: 33051147 DOI: 10.1053/j.jvca.2020.09.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/23/2020] [Accepted: 09/09/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE AngioVac (Angiodynamics, Latham, NY) is a novel drainage system that offers a less-invasive approach compared with open surgical thromboembolectomy to remove intracardiac and intravascular thrombotic and embolic material. For this study, the authors' single-center experience with patients undergoing thromboembolectomy using the AngioVac system was reviewed retrospectively to evaluate anesthetic management and postoperative complications. DESIGN Retrospective, observational study. SETTING Single institution, quaternary care hospital. PARTICIPANTS The study comprised 20 consecutive patients whose treatment included the AngioVac between January 2016 and November 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Twenty patients underwent AngioVac suction filtration. The mean age was 56 years, and women comprised 35% of the patient cohort. Indications for AngioVac suction filtration included deep venous thrombosis involving the inferior vena cava (n = 12 [60%]), right atrial mass/thrombus (n = 11 [55%]), right ventricular mass/thrombus (n = 3 [15%]), and pulmonary embolism(n = 2 [10%]). All patients required vasopressor support, and nine patients (45%) required blood transfusion during the procedure. There was no intraoperative death or cardiac arrest associated with the procedure. The 30-day mortality was zero, and in-hospital mortality was 5% (1/20). Significant postoperative complications occurred in 11/20 patients (55%). Postoperative left ventricular dysfunction (36% v 0%; p < 0.05), preoperative shock requiring vasopressors (36% v 0%; p < 0.05), postoperative blood transfusion (100% v 56%; p < 0.05), and having undergone recent surgery (64% v 11%; p < 0.05) were associated with increased odds of experiencing postoperative complications. CONCLUSIONS The rate of intraoperative complication during AngioVac suction filtration is low, but vasopressors and blood transfusions often are required. Patients at increased risk of developing postoperative complications potentially can be identified as having undergone recent surgery, experiencing preoperative shock requiring vasopressors or postoperative left ventricular dysfunction, and requiring postoperative blood transfusion.
Collapse
Affiliation(s)
- Shu Y Lu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Adam A Dalia
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA.
| | - Maximilian Lang
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| | - Michael G Fitzsimons
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
22
|
Haupt B, Merkle F, Dreizler T, Falk V, Starck C. Technical implementation of percutaneous thrombus aspiration using the AngioVac system. Perfusion 2020; 36:352-356. [PMID: 32787666 DOI: 10.1177/0267659120946734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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.
Collapse
Affiliation(s)
- Benjamin Haupt
- Department of Perfusion, German Heart Center Berlin, Berlin, Germany.,Academy for Perfusion, German Heart Center Berlin, Berlin, Germany
| | - Frank Merkle
- Academy for Perfusion, German Heart Center Berlin, Berlin, Germany.,Steinbeis-Transfer-Institut Kardiotechnik, Steinbeis-Hochschule Berlin, Berlin, Germany
| | - Thomas Dreizler
- Department of Perfusion, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiovascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany.,Department of Cardiothoracic Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Starck
- Steinbeis-Transfer-Institut Kardiotechnik, Steinbeis-Hochschule Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany
| |
Collapse
|
23
|
Liang TM, Martinez JJ, Jessen ME, Wait MA, Shah HM, Lamus D, Huffman LC. Percutaneous Aspiration for Septic Thrombi in Burn Patients. Ann Thorac Surg 2020; 110:e5-e7. [PMID: 31926156 DOI: 10.1016/j.athoracsur.2019.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/06/2019] [Accepted: 11/10/2019] [Indexed: 11/17/2022]
Abstract
Therapeutic interventions are limited for high-risk burn patients with caval and intracardiac septic thrombi. Percutaneous thrombectomy represents a less invasive alternative to median sternotomy. However, there is limited literature on application of this approach and outcomes in these patients. We report two cases of patients with large total body surface area burns with similar caval and right intracardiac septic thrombi. Both patients were successfully treated using a percutaneous aspiration device.
Collapse
Affiliation(s)
- Tyler M Liang
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Joseph J Martinez
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Michael A Wait
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Hriday M Shah
- Division of Vascular Interventional Radiology, Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Daniel Lamus
- Division of Vascular Interventional Radiology, Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Lynn C Huffman
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Texas.
| |
Collapse
|
24
|
Percutaneous Vacuum-Assisted Thrombectomy Using AngioVac Aspiration System. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:489-493. [PMID: 31882331 DOI: 10.1016/j.carrev.2019.12.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/03/2019] [Accepted: 12/16/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Surgical embolectomy and thrombolytic therapy are two common approaches for the treatment of large intra-cardiac or intravascular thrombi to prevent new or worsening pulmonary embolism (PE). Considering high operative mortality with surgical embolectomy and high bleeding risk with thrombolytic therapy, patients who are poor candidates for these treatments may benefit from percutaneous aspiration thrombectomy/Vacuum-assisted thrombectomy (VAT). AngioVac aspiration system was granted 510(k) clearance by the United States Food and Drug Administration (FDA) in April 2009. We present a case series to describe its use and outcomes in evacuating large caval thrombi or intracardiac masses. METHODS We did a retrospective analysis of AngioVac catheter based thrombectomy in 16 consecutive patients treated between January 2016 and January 2019 to report case characteristics and in-hospital clinical outcomes. RESULTS Sixteen patients (mean age 48) underwent 16 AngioVac procedures over 48 months. Indications included intracardiac mass (68.8%), caval thrombus (56.3%), and catheter associated thrombus (43.8%). 7 (43.8%) patients had concurrent PE. Peri-procedure mortality was 0% and in-hospital mortality was 12.5% at a mean follow-up of 14 days. There were no pulmonary hemorrhages, strokes or myocardial infarctions. 62.5% had a significant drop in hemoglobin, which required a blood transfusion but there was no episode of overt bleeding. CONCLUSION The AngioVac aspiration system has been shown to be effective at aspirating large volumes of intravascular and intracardiac thrombus. It is a reasonable alternative to surgical thrombectomy in patients with large central thrombi or masses in-transit who are at risk of complicated PE.
Collapse
|
25
|
Cornman-Homonoff J, Kishore S, Camacho JC, Winokur RS. Intravascular Ultrasound-Guided Extraction of Free-Floating Inferior Vena Cava Tumor Thrombus Using the ClotTriever Mechanical Thrombectomy Device. J Vasc Interv Radiol 2019; 30:1679-1682.e1. [DOI: 10.1016/j.jvir.2019.04.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/24/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022] Open
|
26
|
Ray HM, Al Rstum Z, Saqib NU. Successful cerebral protection during removal of large right atrial thrombus with AngioVac in a patient with patent foramen ovale and recent embolic stroke. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:201-204. [PMID: 31289763 PMCID: PMC6593228 DOI: 10.1016/j.jvscit.2019.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/04/2019] [Indexed: 12/16/2022]
Abstract
Complications associated with central venous catheterization include deep venous thrombosis and atrial thrombi, among others. Large thrombi, including intracardiac thrombi, have classically been managed medically or with open surgery. However, recent reports detail the utility of the AngioVac system (AngioDynamics, Latham, NY), a vacuum-assisted suction thrombectomy system using a venous-venous extracorporeal circuit. Here, we present the case of a critically ill woman with large right atrial thrombus, patent foramen ovale, and recent embolic stroke who underwent successful vacuum-assisted suction thrombectomy with use of the Sentinel Cerebral Protection System (Boston Scientific, Marlborough, Mass) for stroke prevention.
Collapse
Affiliation(s)
- Hunter M Ray
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Tex
| | - Zain Al Rstum
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Tex
| | - Naveed U Saqib
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Tex
| |
Collapse
|
27
|
Percutaneous Aspiration of a Mobile Infected Thrombus from the Right Ventricular Outflow Tract Using the AngioVac System. Case Rep Cardiol 2019; 2019:6279019. [PMID: 31149364 PMCID: PMC6501225 DOI: 10.1155/2019/6279019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/01/2019] [Indexed: 11/30/2022] Open
Abstract
The AngioVac system was invented in 2012 and was originally designed for the removal of thrombi from the venous system. It has been successfully used in the management of iliocaval and right endocardial thrombi but is reportedly less effective in the management of pulmonary emboli (PE). Since its advent, there has been interest in its application towards other medical situations. One of the most revolutionary uses thus far has been for percutaneous debridement of valvular and cardiac electronic device-associated vegetations. In most instances, the AngioVac device has been used to obviate the need for surgery in high-risk patients. Here, we describe a novel use of this device in the successful retrieval of a large, mobile, infected thrombus from the right ventricular outflow tract in a high surgical-risk patient.
Collapse
|
28
|
Kao SD, Edwards MP, Kee ST, Moriarty JM. Salvage of renal transplant with vacuum-assisted thrombectomy of large iliocaval and allograft venous outflow thrombus. ACTA ACUST UNITED AC 2019; 25:238-241. [PMID: 31063144 DOI: 10.5152/dir.2019.18232] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A 47-year-old male with a remote renal transplant due to pediatric glomerulonephritis on oral anticoagulation for symptomatic deep venous thrombosis and pulmonary emboli presented with sudden hip and groin pain. The patient was found to have a spinal epidural hematoma, underwent reversal of anticoagulation, and subsequently developed worsening renal function. Imaging revealed occlusive iliocaval venous thrombosis with extension to the renal allograft. Given risk of epidural hematoma expansion, the patient was deemed high risk for thrombolysis. The AngioVac system was used for single session thrombus removal. The patient's renal function improved and no focal neurologic sequelae was noted postprocedure. Six-month follow-up showed persistent vessel patency.
Collapse
Affiliation(s)
- Steven D Kao
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Martin P Edwards
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Stephen T Kee
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - John M Moriarty
- Department of Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| |
Collapse
|
29
|
Aftab M, Reece TB, Cleveland JC, Pal JD. Noteworthy Cardiac Surgical Literature 2018: Value-Based Bundled Payments, Opioid Crisis and Cardiac Surgery, Percutaneous Suction Thrombectomy for Intracardiac/Caval Thrombus and Vegetations, and Minimally Invasive Left Ventricular Assist Device Placement. Semin Cardiothorac Vasc Anesth 2019; 23:164-170. [DOI: 10.1177/1089253219845417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
There has been tremendous evolution in the care of cardiac surgical patients in 2018. In this article, 4 topics of considerable impact on cardiac surgical care in the current landscape are reviewed based on recent publications. The first topic reviews the recent paradigm shift to value-based payments and the potential role of bundled payments on health care and physician reimbursement. The second topic highlights the impact of the opioid crisis on cardiac surgery. The third topic demonstrates the increasing utilization and expanding role of novel percutaneous suction thrombectomy technique in the extraction of caval and right-sided intracardiac thrombi and vegetations with veno-venous bypass. The final topic reviews the current trend of minimally invasive left ventricular assist device placement. Each of these topics addresses the contemporary issues in cardiac surgery with the reasoning for evolution in our current practices in 2018.
Collapse
Affiliation(s)
- Muhammad Aftab
- Department of Surgery, Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
- Rocky Mountain Regional VA Medical Center, Aurora, Denver, CO, USA
| | - T. Brett Reece
- Department of Surgery, Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
- Rocky Mountain Regional VA Medical Center, Aurora, Denver, CO, USA
| | - Joseph C. Cleveland
- Department of Surgery, Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
- Rocky Mountain Regional VA Medical Center, Aurora, Denver, CO, USA
| | - Jay D. Pal
- Department of Surgery, Division of Cardiothoracic Surgery, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
- Rocky Mountain Regional VA Medical Center, Aurora, Denver, CO, USA
| |
Collapse
|
30
|
Akhmerov A, Reich H, Mirocha J, Ramzy D. Effect of Percutaneous Suction Thromboembolectomy on Improved Right Ventricular Function. Tex Heart Inst J 2019; 46:115-119. [PMID: 31236075 DOI: 10.14503/thij-17-6551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Venous thromboembolism is a leading cause of cardiovascular death. Historically, surgical intervention has been associated with high morbidity rates. Pharmacologic therapy alone can be inadequate for patients with substantial hemodynamic compromise, so minimally invasive procedures are being developed to reduce clot burden. We describe our initial experience with using the AngioVac system to remove thromboemboli percutaneously. We reviewed all suction thromboembolectomy procedures performed at our institution from March 2013 through August 2015. The main indications for the procedure were failed catheter-directed therapy, contraindication to thrombolysis, bleeding-related complications, and clot-in-transit phenomena. We collected details on patient characteristics, procedural indications, thrombus location, hemodynamic values, cardiac function, pharmacologic support, and survival to discharge from the hospital. The Wilcoxon signed-rank test was used for statistical analysis. Thirteen patients (mean age, 56 ± 15 yr; 10 men) underwent suction thromboembolectomy; 10 (77%) survived to hospital discharge. The median follow-up time was 74 days (interquartile range [IQR], 23-221 d). Preprocedurally, 8 patients (62%) had severe right ventricular dysfunction; afterwards, 11 (85%) had normal function or mild-to-moderate dysfunction, and only 2 (17%) had severe dysfunction (P=0.031). Percutaneous suction thromboembolectomy, a promising therapeutic option for patients, appears to be safe, and we found it to be associated with improved right ventricular function.
Collapse
|
31
|
Hameed I, Lau C, Khan FM, Wingo M, Rahouma M, Leonard JR, Di Franco A, Worku BM, Salemi A, Girardi LN, Gaudino M. AngioVac for extraction of venous thromboses and endocardial vegetations: A meta‐analysis. J Card Surg 2019; 34:170-180. [DOI: 10.1111/jocs.14009] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 01/24/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Irbaz Hameed
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Christopher Lau
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Faiza M. Khan
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Matthew Wingo
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Mohamed Rahouma
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Jeremy R. Leonard
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Antonino Di Franco
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Berhane M. Worku
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Arash Salemi
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Leonard N. Girardi
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| | - Mario Gaudino
- Department of Cardiothoracic SurgeryWeill Cornell MedicineNew York New York
| |
Collapse
|
32
|
Large Solid Right Atrial Thrombus Treated by AngioVac Catheter-Based Suction Thrombectomy. Case Rep Cardiol 2018; 2018:7904064. [PMID: 30533229 PMCID: PMC6250021 DOI: 10.1155/2018/7904064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/01/2018] [Indexed: 11/17/2022] Open
Abstract
We present the successful treatment of a large solid right atrial thrombus by the catheter-based suction embolectomy system AngioVac® (AngioDynamics, NY, USA). A previously healthy 60-year-old male was referred with acute pulmonary embolism, a large deep vein thrombus and a large right atrial thrombus. After one week of anticoagulation, the size of the atrial thrombus was unaltered, and the patient was treated by catheter-directed embolectomy using the AngioVac system. The solid thrombus occluded the catheter during the procedure. With the vacuum maintained, the occluded catheter was removed from the patient and the thrombus mass was removed. The remaining atrial thrombus was successfully removed by suction after the reinsertion of the catheter. The patient recovered well and was discharged 7 days after the procedure. The therapy was safe and minimally invasive.
Collapse
|
33
|
Koney N, Benmessaoud C, Cole KY, Bulut Y, Yang EH, Moriarty JM. Percutaneous Removal of a Cardiac Mass in a Patient with Infective Endocarditis: A Case Report. J Pediatr Intensive Care 2018; 8:103-107. [PMID: 31093464 DOI: 10.1055/s-0038-1675194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022] Open
Abstract
Infective endocarditis (IE) in the pediatric population is uncommon and presents with nonspecific signs. Nonetheless, prompt diagnosis and management are critical given its high mortality rate. We present the case of a 15-year-old boy who initially presented with bilateral multifocal pneumonia and was found to have IE with a right ventricular vegetation. The vegetation was removed percutaneously, obviating a more invasive surgical approach. The patient tolerated the procedure well and rapidly improved following removal of the vegetation. This case report highlights the utility of a novel, minimally invasive approach for the management of cardiac masses.
Collapse
Affiliation(s)
- Nii Koney
- Division of Interventional Radiology, Department of Radiological Sciences, University of California, Los Angeles, California, United States.,Division of Interventional Radiology, Department of Radiology, Northwest Permanente, Portland, Oregon, United States
| | - Chelsea Benmessaoud
- David Geffen School of Medicine, University of California, Los Angeles, California, United States
| | - Kalonji Y Cole
- David Geffen School of Medicine, University of California, Los Angeles, California, United States
| | - Yonca Bulut
- Division of Critical Care Medicine, Department of Pediatrics, University of California, Los Angeles, California, United States
| | - Eric H Yang
- Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, United States
| | - John M Moriarty
- Division of Interventional Radiology, Department of Radiological Sciences, University of California, Los Angeles, California, United States.,Division of Cardiology, Department of Medicine, University of California, Los Angeles, California, United States
| |
Collapse
|
34
|
Jabaar AA, Jenkins JS. The role of vacuum assisted thrombectomy (AngioVac) in treating chronic venous thromboembolic disease. Systematic review and a single center's experience. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018. [DOI: 10.1016/j.carrev.2018.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
35
|
Starck CT, Eulert-Grehn J, Kukucka M, Eggert-Doktor D, Dreizler T, Haupt B, Falk V. Managing large lead vegetations in transvenous lead extractions using a percutaneous aspiration technique. Expert Rev Med Devices 2018; 15:757-761. [PMID: 30247076 DOI: 10.1080/17434440.2018.1525292] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Treatment of patients with systemic infections of cardiac implantable electronic devices and large lead vegetations are a clinical challenge. In such situations patients potentially had to undergo open surgical extraction in the past. The objective of this study was to evaluate the results of a concomitant percutaneous, minimal-invasive aspiration procedure with the use of an extracorporeal circulation in transvenous lead extraction procedures in patients with large lead vegetations. RESEARCH DESIGN AND METHODS Prior and during transvenous lead extraction procedures lead vegetations were targeted for removal with a percutaneous aspiration technique based on a veno-venous extracorporeal circulation with an in-line filter. Clinical outcomes of the procedures were retrospectively analyzed. RESULTS This innovative and minimal-invasive treatment concept was used in 35 patients with systemic CIED infections (mean echocardiographic lead vegetation size 22.6 (12-40) mm). Complete procedural success of the aspiration procedure was seen in 88.6% of the patients. No major complication related to the aspiration procedure occurred. Clinical success of the concomitant transvenous lead extraction procedures (35 patients, 83 leads) was 97.1%. CONCLUSION The presented data show that the aspiration procedure is safe and efficient as an adjunct in transvenous lead extraction procedures avoiding the need for open surgical extraction in such cases.
Collapse
Affiliation(s)
- Christoph T Starck
- a Department of Cardiothoracic & Vascular Surgery , German Heart Center Berlin , Berlin , Germany.,b DZHK (German Center for Cardiovascular Research), partner site Berlin , Berlin , Germany.,c Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion , Berlin , Germany
| | - Jürgen Eulert-Grehn
- a Department of Cardiothoracic & Vascular Surgery , German Heart Center Berlin , Berlin , Germany.,b DZHK (German Center for Cardiovascular Research), partner site Berlin , Berlin , Germany
| | - Marian Kukucka
- d German Heart Center Berlin , Institute for Anesthesiology , Berlin , Germany
| | - Dirk Eggert-Doktor
- d German Heart Center Berlin , Institute for Anesthesiology , Berlin , Germany
| | - Thomas Dreizler
- e German Heart Center Berlin, Department of Cardiothoracic & Vascular Surgery , Team of Cardiovascular Perfusion , Berlin , Germany
| | - Benjamin Haupt
- e German Heart Center Berlin, Department of Cardiothoracic & Vascular Surgery , Team of Cardiovascular Perfusion , Berlin , Germany
| | - Volkmar Falk
- a Department of Cardiothoracic & Vascular Surgery , German Heart Center Berlin , Berlin , Germany.,b DZHK (German Center for Cardiovascular Research), partner site Berlin , Berlin , Germany.,f Clinic of Cardiac Surgery , University Hospital Charité Berlin , Berlin , Germany
| |
Collapse
|
36
|
Ahmed M, Montford JH, Lau E. Vacuum-assisted right atrial infected clot extraction due to persistent bacteraemia: a percutaneous approach for the management of right-sided endocarditis. BMJ Case Rep 2018; 2018:bcr-2018-226493. [PMID: 30181406 DOI: 10.1136/bcr-2018-226493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 56-year-old woman with non-ischaemic cardiomyopathy with implantable cardioverter defibrillator (ICD) presented to the hospital with progressive dyspnoea of 4 weeks' duration. She soon spiralled down to develop septic shock with methicillin-sensitive Staphylococcus aureus bacteraemia. A transoesophageal echocardiogram revealed a 2.4×2.1 cm large mobile echodensity in the right atrium likely attached to the ICD lead and to the interatrial septum. Although the ICD along with its leads was extracted, bacteraemia persisted despite appropriate antibiotic therapy. Because of her worsening condition, she underwent a right atrial infected clot extraction by the AngioVac system. Her clinical condition noticeably improved soon after evacuation of the infected clot.
Collapse
Affiliation(s)
- Mashrafi Ahmed
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Illinois, USA
| | | | - Evan Lau
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, Illinois, USA
| |
Collapse
|
37
|
Qureshi AM, Mullins CE, Latson LA. Recent advances in managing vascular occlusions in the cardiac catheterization laboratory. F1000Res 2018; 7. [PMID: 29770200 PMCID: PMC5931263 DOI: 10.12688/f1000research.13271.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 11/28/2022] Open
Abstract
Vascular occlusions continue to be a significant cause of morbidity and mortality. The management of vascular occlusions in patients is complex, requiring specialized expertise in the cardiac catheterization laboratory and from other disciplines. Knowledge of currently available tools at the operator’s disposal is important to optimize the success of these procedures. In this review, we discuss some of the recent advances in recanalization procedures of vascular occlusions and thrombotic lesions in the cardiac catheterization laboratory.
Collapse
Affiliation(s)
- Athar M. Qureshi
- CE Mullins Cardiac Catheterization Laboratories, The Lillie Frank Abercrombie Section, Texas Children’s Hospital of Cardiology, 6621 Fannin Street, Houston, TX 77030, USA
- Internal Medicine/Cardiology, Baylor St. Luke’s Medical Center, 6621 Fannin Street, West Tower, 19th Floor, MC 19345C, Houston, TX 77030, USA
| | - Charles E. Mullins
- CE Mullins Cardiac Catheterization Laboratories, The Lillie Frank Abercrombie Section, Texas Children’s Hospital of Cardiology, 6621 Fannin Street, Houston, TX 77030, USA
| | - Larry A. Latson
- Joe DiMaggio Children's Hospital and Center for Adult Congenital Heart Disease, Memorial Healthcare System, 1005 Joe Dimaggio Drive Pediatric Heart Station Hollywood, FL 33021, USA
| |
Collapse
|
38
|
Abstract
Pulmonary embolism (PE) is a serious and prevalent cause of vascular disease. Nevertheless, optimal treatment for many phenotypes of PE remains uncertain. Treating PE requires appropriate risk stratification as a first step. For the highest-risk PE, presenting as shock or arrest, emergent systemic thrombolysis or embolectomy is reasonable, while for low-risk PE, anticoagulation alone is often chosen. Normotensive patients with PE but with indicia of right heart dysfunction (by biomarkers or imaging) constitute an intermediate-risk group for whom there is controversy on therapeutic strategy. Some intermediate-risk patients with PE may require urgent stabilization, and ≈10% will decompensate hemodynamically and suffer high mortality, though identifying these specific patients remains challenging. Systemic thrombolysis is a consideration, but its risks of major and intracranial hemorrhages rival overall harms from intermediate PE. Multiple hybrid pharmacomechanical approaches have been devised to capture the benefits of thrombolysis while reducing its risks, but there is limited aggregate clinical experience with such novel interventional strategies. One method to counteract uncertainty and generate a consensus multidisciplinary prognostic and therapeutic plan is through a Pulmonary Embolism Response Team, which combines expertise from interventional cardiology, interventional radiology, cardiac surgery, cardiac imaging, and critical care. Such a team can help determine which intervention-catheter-directed fibrinolysis, ultrasound-assisted thrombolysis, percutaneous mechanical thrombus fragmentation, or percutaneous or surgical embolectomy-is best suited to a particular patient. This article reviews these various modalities and the background for each.
Collapse
Affiliation(s)
- David M Dudzinski
- From the Cardiology Division (D.M.D., K.R.) and Vascular Medicine (K.R.), Massachusetts General Hospital, Boston; and Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia (J.G.).
| | - Jay Giri
- From the Cardiology Division (D.M.D., K.R.) and Vascular Medicine (K.R.), Massachusetts General Hospital, Boston; and Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia (J.G.)
| | - Kenneth Rosenfield
- From the Cardiology Division (D.M.D., K.R.) and Vascular Medicine (K.R.), Massachusetts General Hospital, Boston; and Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia (J.G.)
| |
Collapse
|
39
|
Shah KS, Mohan PP, Salsamendi JT. The Utility of Transesophageal Echocardiogram and Transabdominal Ultrasound for Facilitation of Inferior Vena Cava and Right Atrial Thrombus Removal Using AngioVac System. Cardiovasc Intervent Radiol 2017; 41:197-199. [DOI: 10.1007/s00270-017-1775-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 08/17/2017] [Indexed: 10/19/2022]
|
40
|
Kohi MP, Kohlbrenner R, Kolli KP, Lehrman E, Taylor AG, Fidelman N. Catheter directed interventions for acute deep vein thrombosis. Cardiovasc Diagn Ther 2016; 6:599-611. [PMID: 28123980 DOI: 10.21037/cdt.2016.11.20] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Venous thromboembolism (VTE) is an extremely common form of vascular disease and impacts a great number of patients worldwide. Acute deep vein thrombosis (DVT) is a subset of VTE and is traditionally been treated with anticoagulation. There is good quality data which suggests the use of catheter directed interventions for the treatment of acute DVT with the aim of reducing post-thrombotic syndrome (PTS). The present review will discuss the various therapies available for acute DVT, focusing on catheter directed interventions, ranging from traditional anticoagulation to the most novel forms of aspiration thrombectomy.
Collapse
Affiliation(s)
- Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Ryan Kohlbrenner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Kanti P Kolli
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Evan Lehrman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Andrew G Taylor
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Nicholas Fidelman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| |
Collapse
|