PURPOSE: To present the technique for removing mural thrombus from the ascending aorta using the AngioVac System. TECHNIQUE: The technique is demonstrated in a 66-year-old woman who presented with free-floating mural thrombus in the ascending aorta and was considered unsuitable for either open (comorbidities) or endovascular approaches (high risk of stroke). Because of the free-floating thrombus, the Angiovac system was suggested, although it is approved for only the venous system. The technique was adapted for the arterial system with the 2 access points being (1) the proximal left subclavian artery with a 10-mm conduit for device access and (2) the right femoral vein. The AngioVac cannula and the reinfusion cannula were inserted into the artery and vein, respectively. The extracorporeal bypass circuit was created, and the carotid arteries were clamped during aspiration (<1 minute). The mural thrombus was aspirated successfully. The patient had an uneventful postoperative course with no signs of free thrombus on the postoperative or follow-up computed tomography angiograms. CONCLUSION: The use of the AngioVac System seems to be a feasible technique for aspiration of thrombus from the ascending aorta. Expanding this therapeutic option for patients unsuitable for open or endovascular repair may be proven efficient in the near future.
PURPOSE: To present the technique for removing mural thrombus from the ascending aorta using the AngioVac System. TECHNIQUE: The technique is demonstrated in a 66-year-old woman who presented with free-floating mural thrombus in the ascending aorta and was considered unsuitable for either open (comorbidities) or endovascular approaches (high risk of stroke). Because of the free-floating thrombus, the Angiovac system was suggested, although it is approved for only the venous system. The technique was adapted for the arterial system with the 2 access points being (1) the proximal left subclavian artery with a 10-mm conduit for device access and (2) the right femoral vein. The AngioVac cannula and the reinfusion cannula were inserted into the artery and vein, respectively. The extracorporeal bypass circuit was created, and the carotid arteries were clamped during aspiration (<1 minute). The mural thrombus was aspirated successfully. The patient had an uneventful postoperative course with no signs of free thrombus on the postoperative or follow-up computed tomography angiograms. CONCLUSION: The use of the AngioVac System seems to be a feasible technique for aspiration of thrombus from the ascending aorta. Expanding this therapeutic option for patients unsuitable for open or endovascular repair may be proven efficient in the near future.
Authors: Ana Paula Donadello Martins; Leonardo Henrique Bertolucci; Rodrigo Batista Warpechowski; Arthur Angonese; Mariana Saadi de Azevedo; Camilla Rodrigues; Alfredo Augusto Schulte; Silvio Cesar Perini Journal: J Vasc Bras Date: 2022-09-09