Marcus D'Ayala1, Berhane Worku2, Iosif Gulkarov3, Akhilesh Sista4, James Horowitz5, Arash Salemi6. 1. Division of Vascular Surgery, New York Methodist Hospital, Brooklyn, NY. 2. Department of Cardiothoracic Surgery, New York Methodist Hospital, Brooklyn, NY; Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY. Electronic address: bmworku@hotmail.com. 3. Department of Cardiothoracic Surgery, New York Methodist Hospital, Brooklyn, NY; Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY. 4. Department of Radiology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY. 5. Department of Cardiology, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY. 6. Department of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY.
Abstract
BACKGROUND: The AngioVac (AngioDynamics, Latham, NY) device utilizes a venovenous bypass circuit for percutaneous venous thrombectomy and has been applied in the setting of iliocaval thrombosis as well as right heart thrombus and pulmonary emboli. We describe our experience with the AngioVac device in 12 patients with a variety of indications with the goal of identifying factors correlating with successful thrombectomy. METHODS: From August 2013 to June 2015, 12 patients underwent AngioVac percutaneous thrombectomy at our institution. Preoperative, intraoperative, and postoperative data were retrospectively analyzed. RESULTS: Indications for thrombectomy included iliocaval thrombosis in 33% (4), right heart thrombus in 42% (5), and pulmonary embolus in 25% (3). We experienced a 58% complete success rate. Partial success was achieved in 17%, and no thrombus was extracted in 25%. Iliocaval and right heart thrombi were the most amenable to AngioVac thrombectomy with 100% (4/4) and 60% (3/5) complete success rates, respectively. Pulmonary embolus was the least amenable to thrombectomy with a 33% partial success rate (1/3) and 67% failure rate (2/3). CONCLUSION: The AngioVac devices allow for percutaneous thrombectomy in the setting of iliocaval and right heart thrombus in patients for whom medical therapy fails or for those in whom surgical intervention is considered high risk. Pulmonary emboli are less amenable, likely due to limited steeribility of the device. Larger studies are needed to make more definitive conclusions, and newer iterations of the device will likely allow for improved outcomes.
BACKGROUND: The AngioVac (AngioDynamics, Latham, NY) device utilizes a venovenous bypass circuit for percutaneous venous thrombectomy and has been applied in the setting of iliocaval thrombosis as well as right heart thrombus and pulmonary emboli. We describe our experience with the AngioVac device in 12 patients with a variety of indications with the goal of identifying factors correlating with successful thrombectomy. METHODS: From August 2013 to June 2015, 12 patients underwent AngioVac percutaneous thrombectomy at our institution. Preoperative, intraoperative, and postoperative data were retrospectively analyzed. RESULTS: Indications for thrombectomy included iliocaval thrombosis in 33% (4), right heart thrombus in 42% (5), and pulmonary embolus in 25% (3). We experienced a 58% complete success rate. Partial success was achieved in 17%, and no thrombus was extracted in 25%. Iliocaval and right heart thrombi were the most amenable to AngioVac thrombectomy with 100% (4/4) and 60% (3/5) complete success rates, respectively. Pulmonary embolus was the least amenable to thrombectomy with a 33% partial success rate (1/3) and 67% failure rate (2/3). CONCLUSION: The AngioVac devices allow for percutaneous thrombectomy in the setting of iliocaval and right heart thrombus in patients for whom medical therapy fails or for those in whom surgical intervention is considered high risk. Pulmonary emboli are less amenable, likely due to limited steeribility of the device. Larger studies are needed to make more definitive conclusions, and newer iterations of the device will likely allow for improved outcomes.
Authors: Scott D Miller; Daniel C Lee; Bradley T Dollar; Shawn R Schepel; Alexander Shestopalov; William C Culp Journal: Proc (Bayl Univ Med Cent) Date: 2019-10-08
Authors: Santiago Rolon; Jacob C Wood; Neel A Mansukhani; Robert A Hieb; Michael J Malinowski; Brian D Lewis; Kellie R Brown; Peter J Rossi Journal: J Vasc Surg Cases Innov Tech Date: 2021-05-21