Removal of Caval and Right Atrial Thrombi and Masses Using the AngioVac Device: Initial Operative Experience

To describe initial single-center experience with a thrombectomy device in managing right atrial and caval thrombi, tumors, and vegetations.

A retrospective analysis of AngioVac thrombectomy performed in 16 patients (mean age 53 y ± 13; 8 men, 8 women) between August 2013 and August 2015 was performed. Indications included right atrial mass/thrombus (6/16; 37.5%) and iliocaval thrombus (10/16; 62.5%). Procedural success was defined as aspiration of > 70% volume of atrial mass/thrombus or restoration of antegrade caval flow.

Procedural success was achieved in 4/6 (67%) right atrial masses/thrombi and 10/10 (100%) caval thrombi. All patients (8/8; 100%) with caval thrombus presenting with swelling/edema had improvement or resolution of symptoms. There were no procedural or periprocedural mortalities; complications included one major (6.3%; intraprocedural pulmonary embolus) and one minor (6.3%; access site hematoma not requiring transfusion) complication. Of 16 patients, 14 (87.5%) survived to discharge at a mean of 10 days ± 8 (range, 1-23 d), and 12 patients (75%) were alive at last known follow-up at a mean of 385 days ± 267 (range, 63-730 d). At a mean of 194 days ± 177 (range, 41-372 d), 4/16 (25%) patients were dead; no death was related to AngioVac thrombectomy. At a mean of 66 days ± 21 (range, 49-90 d) after intervention, 3/14 (21.4%) cases with procedural success had local recurrence of mass/thrombus.

AngioVac thrombectomy can be performed with high procedural success with clinical benefit in patients with right atrial and caval masses/thrombi.