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Removal of Caval and Right Atrial Thrombi and Masses Using the AngioVac Device: Initial Operative Experience
John M Moriarty1, Ramsey Al-Hakim1, Anshuman Bansal1
1Division of Interventional Radiology, Department of Radiology, University of California, Los Angeles, 757 Westwood Pl., Los Angeles, CA 90095.
Insights
The AngioVac thrombectomy device shows high procedural success in removing right atrial and caval masses, offering clinical benefits for patients. This minimally invasive technique provides a safe and effective treatment option for complex thrombi and tumors.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Device Technology
Background:
- Right atrial and caval masses, including thrombi, tumors, and vegetations, pose significant clinical challenges.
- Traditional management strategies may carry substantial risks and limitations.
Purpose of the Study:
- To evaluate the initial single-center experience with the AngioVac thrombectomy system.
- To assess its efficacy and safety in managing right atrial and caval masses.
Main Methods:
- Retrospective analysis of 16 patients undergoing AngioVac thrombectomy (August 2013 - August 2015).
- Indications included right atrial mass/thrombus (37.5%) and iliocaval thrombus (62.5%).
- Procedural success defined as >70% volume aspiration or restoration of antegrade caval flow.
Main Results:
- High procedural success rates: 67% for atrial masses and 100% for caval thrombi.
- Significant symptom improvement or resolution in 100% of patients with caval thrombus and edema.
- Low complication rate (6.3% major, 6.3% minor); no procedural mortalities.
- Survival to discharge 87.5%, with 75% alive at long-term follow-up; no deaths attributed to the device.
Conclusions:
- AngioVac thrombectomy is a safe and effective procedure for managing right atrial and caval masses.
- The device demonstrates high procedural success and provides clinical benefit to patients.
- Further investigation into recurrence rates and long-term outcomes is warranted.
Purpose:
To describe initial single-center experience with a thrombectomy device in managing right atrial and caval thrombi, tumors, and vegetations.
Materials And Methods:
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.
Results:
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.
Conclusions:
AngioVac thrombectomy can be performed with high procedural success with clinical benefit in patients with right atrial and caval masses/thrombi.
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