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Wilson WR, McCusker KH, Peeran SM, Dourdoufis PJ. Endovascular removal of a large free-floating thrombus of the descending thoracic aorta using the AngioVac system. J Vasc Surg Cases Innov Tech 2024; 10:101460. [PMID: 38591019 PMCID: PMC11000156 DOI: 10.1016/j.jvscit.2024.101460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/13/2024] [Indexed: 04/10/2024] Open
Abstract
Free-floating aortic mural thrombus in the minimally diseased or nonaneurysmal aorta is a rare, clinically significant source of peripheral embolism. We describe a 41-year-old woman with a history of left brachial thromboembolectomy who presented atypical chest pain. Computed tomography angiography and transesophageal echocardiography revealed a 14.0 cm × 1.4 cm mobile mass in the proximal descending thoracic aorta. The thrombus was removed through a minimally invasive catheter-based approach using the AngioVac system.
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Affiliation(s)
- William R. Wilson
- Department of Cardiothoracic and Vascular Surgery, Portsmouth Regional Hospital, Portsmouth, NH
| | - Kevin H. McCusker
- Department of Cardiothoracic and Vascular Surgery, Portsmouth Regional Hospital, Portsmouth, NH
| | - Syed M. Peeran
- Department of Cardiothoracic and Vascular Surgery, Portsmouth Regional Hospital, Portsmouth, NH
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Durante J, Santarsieri M, Manassero F, Fiorini G, Cariello C, Lippolis P, Colli A, Pomara G. Robotic left nephrectomy with level IV inferior vena cava thrombectomy using the AngioVac system. Cent European J Urol 2024; 77:159-160. [PMID: 38645809 PMCID: PMC11032026 DOI: 10.5173/ceju.2023.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/03/2023] [Accepted: 12/03/2023] [Indexed: 04/23/2024] Open
Affiliation(s)
- Jacopo Durante
- Department of Urology (Urologia II SSN), Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Michele Santarsieri
- Department of Urology (Urologia II SSN), Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Francesca Manassero
- Department of Urology (Urologia II SSN), Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Girolamo Fiorini
- Department of Urology (Urologia II SSN), Cisanello Hospital, University of Pisa, Pisa, Italy
| | - Claudia Cariello
- Department of Anaesthesia and Critical Care Medicine, Cardiothoracic Anaesthesia and Intensive Care, University Hospital of Pisa, Pisa, Italy
| | - Piero Lippolis
- General and Peritoneal Surgery Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Andrea Colli
- Section of Cardiac Surgery, University of Pisa, Pisa, Italy
| | - Giorgio Pomara
- Department of Urology (Urologia II SSN), Cisanello Hospital, University of Pisa, Pisa, Italy
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Neubauer S, Gianfrate G, Henn L. 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 DOI: 10.1186/s13019-021-01605-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
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Tarzia V, Tessari C, Bagozzi L, Migliore F, Pittarello D, Zanella F, Bertaglia E, Fabozzo A, Gerosa G. Totally peripheral approach for ICD lead vegetation removal in a GUCH patient. J Cardiovasc Electrophysiol 2021; 32:1778-1781. [PMID: 33825266 DOI: 10.1111/jce.15032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/11/2021] [Accepted: 03/18/2021] [Indexed: 11/30/2022]
Abstract
AngioVac system (AngioDynamics) has already proved to be a useful tool in the treatment of thrombotic and endocarditic formations concerning the venous district. Herein, the AngioVac aspiration system combined with the bidirectional rotational Evolution mechanical sheath lead extraction was used for an effective and safety cardiac-device-related-infective-endocarditis removal in a grown-up congenital heart disease patient through a totally peripheral approach.
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Affiliation(s)
- Vincenzo Tarzia
- Cardiac Surgery Unit, Department of Cardio-Thorac-Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Chiara Tessari
- Cardiac Surgery Unit, Department of Cardio-Thorac-Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Lorenzo Bagozzi
- Cardiac Surgery Unit, Department of Cardio-Thorac-Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Federico Migliore
- Cardiology Unit, Department of Cardio-Thorac-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Demetrio Pittarello
- Cardiac Surgery Unit, Department of Cardio-Thorac-Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Fabio Zanella
- Cardiac Surgery Unit, Department of Cardio-Thorac-Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Emanuele Bertaglia
- Cardiology Unit, Department of Cardio-Thorac-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Assunta Fabozzo
- Cardiac Surgery Unit, Department of Cardio-Thorac-Vascular Sciences, and Public Health, University of Padova, Padova, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardio-Thorac-Vascular Sciences, and Public Health, University of Padova, Padova, Italy
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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.
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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
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Patel H, Castellanos LR, Golts E, Reeves R, Mahmud E, Hsu JC. Spontaneous Left Atrial Thrombus Formation on the Catheter Delivery System During WATCHMAN Implantation. JACC Case Rep 2020; 2:444-448. [PMID: 34317260 PMCID: PMC8311618 DOI: 10.1016/j.jaccas.2019.10.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/28/2019] [Accepted: 10/31/2019] [Indexed: 11/19/2022]
Abstract
We present a rare complication of spontaneous thrombus formation on the WATCHMAN delivery system, on both the right- and left-sided systemic circulation. We also describe the multidisciplinary team approach and the use of percutaneous vacuum-assisted aspiration system (AngioVac, AngioDynamics, Latham, New York) for successful thrombus removal. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Hiren Patel
- Division of Cardiovascular Medicine, Advanced Cardiac Imaging Fellowship Program, University of California-San Diego, La Jolla, California
| | - Luis R. Castellanos
- Division of Cardiovascular Medicine, University of California-San Diego, La Jolla, California
| | - Eugene Golts
- Division of Cardiothoracic Surgery, University of California-San Diego, La Jolla, California
| | - Ryan Reeves
- Division of Cardiovascular Medicine, University of California-San Diego, La Jolla, California
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine, University of California-San Diego, La Jolla, California
| | - Jonathan C. Hsu
- Division of Cardiovascular Medicine, University of California-San Diego, La Jolla, California
- Address for correspondence: Dr. Jonathan C. Hsu, Cardiac Electrophysiology Section, Division of Cardiovascular Medicine, Department of Medicine, University of California-San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, La Jolla, California 92037.
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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. J Vasc Surg Cases Innov Tech 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Abstract
Patients with pulmonary embolism (PE) present with highly variable clinical symptoms and often have accompanying comorbidities. Timely diagnosis and treatment are critical to help prevent recurrence and increased morbidity/mortality. While open surgical thrombectomy was once reserved only for those with massive PE and hemodynamic compromise, it has been reevaluated with a focus on careful patient selection and early intervention. Lately, there has been increased interest in catheter-based interventions and in combining these with an open surgical component to decrease the magnitude of the intervention-for example, direct placement of large-bore thrombectomy devices directly into the right ventricle via sternotomy or subxiphoid approaches. In addition, improved diagnostic capabilities have allowed for expedited diagnosis and treatment of patients with life-threatening PE. At our institution, a hybrid room allows patients suspected of having a massive or submassive PE to undergo on-table contrast-enhanced cone-beam computed tomography scan, thus creating a high-resolution 3-dimensional image of the arterial system that can provide immediate guidance for therapeutic intervention. This review highlights the array of therapeutic options currently used in our armamentarium at the Houston Methodist DeBakey Heart & Vascular Center and describes our development of a pulmonary angioplasty procedure that we believe will greatly facilitate selective thrombus removal in the acute PE setting.
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Affiliation(s)
- Alan B Lumsden
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Erik Suarez
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
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