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Angiojet rheolytic thrombectomy in infants following cardiac surgery
Gregory A Fleming1, Muhammed Khan, Dana Janssen
1Division of Pediatric Cardiology, Department of Pediatrics, Monroe Carell Jr. Children's Hospital, Vanderbilt University, Nashville, TN 37232, USA. gregory.fleming@vanderbilt.edu
Insights
Angiojet thrombectomy effectively treated life-threatening thrombosis in infants after cardiac surgery. This percutaneous method showed significant flow improvement with a 62.5% survival rate to discharge.
Area of Science:
- Cardiology
- Pediatric Surgery
- Interventional Radiology
Background:
- Postoperative thrombosis is a critical risk for infants undergoing cardiac surgery.
- Current treatment methods for pediatric thrombosis lack established optimal protocols.
- Angiojet rheolytic thrombectomy offers a percutaneous approach for thrombus removal, with demonstrated efficacy in adults.
Purpose of the Study:
- To evaluate the safety and efficacy of the Angiojet thrombectomy system.
- To assess its application in infants experiencing thrombosis after cardiac surgery.
Main Methods:
- A retrospective review of medical records and angiograms was conducted.
- Ten Angiojet thrombectomy procedures were analyzed in eight infants between 2005 and 2007.
- Indications included severe cyanosis, venous thrombosis, and iliac artery thrombosis.
Main Results:
- Procedures were performed a mean of 23 days post-surgery in infants aged a mean of 74 days.
- Thrombus removal occurred from pulmonary arteries, systemic veins, aorto-pulmonary shunts, and iliac arteries.
- Significant flow improvement was observed in all patients, with one major complication and no procedural deaths. Hospital survival to discharge was 62.5%.
Conclusions:
- Angiojet thrombectomy is a viable and effective treatment for critical postoperative thrombosis in infants.
- The procedure demonstrated success in improving blood flow and managing life-threatening thrombotic events.
Objectives:
To present our experience with the Angiojet thrombectomy system for percutaneous thrombectomy in infants following cardiac surgery.
Background:
Arterial and venous thrombosis after pediatric cardiac surgery is life threatening, particularly in infants. The best method for treating these patients has not been determined. Angiojet rheolytic thrombectomy (Possis Medical, Minneapolis, MN) is a percutaneous method of thrombus removal with proven safety and efficacy in adults.
Methods:
We reviewed the medical records and angiograms of all procedures in which Angiojet thrombectomy was used in infants following cardiac surgery at our institution during the years 2005 through 2007.
Results:
Ten procedures were performed in eight infants. The procedure was performed a mean of 23 days from surgery. The mean age was 74 days with a mean weight of 4.3 kg. All patients had life or limb threatening thrombosis. Indications for thrombectomy included severe cyanosis, chronic pleural effusions secondary to extensive venous thrombosis, and acute iliac artery thrombosis. Thrombus was evacuated from pulmonary arteries in four patients, systemic veins in two patients, a surgical aorto-pulmonary shunt in two patients, and an iliac artery in one patient. Balloon angioplasty following thrombectomy was performed in eight procedures (80%), and stents were placed in addition to angioplasty in two procedures. All patients had significant improvement in flow across the affected area. There was one major complication and three minor complications with no procedural-related deaths. Survival to discharge from the hospital was 62.5%.
Conclusion:
Angiojet thrombectomy is an effective treatment for life-threatening postoperative thrombosis in infants following cardiac surgery.
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