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Successful IVC thrombus extraction with the AngioVac device following five vessel coronary artery bypass graft: a
Steven Neubauer1, Gianmarino Gianfrate2, Lucas Henn1
1Department of General Surgery, Mercy Health St. Elizabeth Youngstown Hospital, 1044 Belmont Ave, Youngstown, OH, USA.
Insights
Inferior vena cava thrombosis, a complication of IVC filter placement and bypass surgery, can lead to severe outcomes. A suction thrombectomy with the AngioVac device successfully treated extensive thrombosis and right heart failure in a post-operative patient.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Inferior vena cava (IVC) thrombosis is a known complication following IVC filter placement and coronary artery bypass surgery.
- While often asymptomatic, chronic thrombi can lead to serious complications, including right heart failure.
- Anticoagulation is the standard treatment, but not always feasible or effective for all patients.
Observation:
- A 65-year-old male developed extensive femoral and iliocaval thrombosis post-coronary artery bypass surgery and IVC filter placement.
- The patient presented with bilateral pulmonary emboli and deep vein thrombosis, progressing to right heart failure and cardiogenic shock despite anticoagulation.
- Diagnosis revealed an IVC thrombus as the cause of decompensation.
Findings:
- Suction thrombectomy using the AngioVac aspiration device was performed to address the extensive IVC thrombus.
- The thrombectomy procedure was successful in removing the thrombus.
- The patient recovered from right heart failure and cardiogenic shock and was discharged.
Implications:
- This case highlights the potential mortality associated with IVC thrombosis in the post-operative setting.
- The AngioVac device demonstrated efficacy as a treatment option for IVC thrombus when anticoagulation failed.
- Further investigation into the AngioVac device for managing complex IVC thrombosis is warranted.
Background:
Inferior vena cava thrombosis is cited to be a complication of inferior vena cava filter placement and post coronary artery bypass surgery. Often only mild symptoms arise from these thrombi; however, due to the chronic nature of some thrombi and the recanalization process, more serious complications can arise. Although anticoagulation remains the gold standard of treatment, some patients are unable to be anticoagulated. In this case, we present a 65-year-old male who underwent IVC filter placement and open-heart surgery who later developed extensive femoral and iliocaval thrombosis leading to right heart failure, which required thrombus extraction with an AngioVac suction device.
Case Presentation:
We present a 65-year-old male who presented with bilateral pulmonary emboli with extensive right lower extremity deep vein thrombosis. Upon investigation he had ischemic heart disease and underwent a five-vessel coronary artery bypass for which he had an IVC filter placed preoperatively. On post operative day 3 to 4, he was decompensated and was diagnosed with an IVC thrombus. He progressed to right heart failure and worsening cardiogenic shock despite therapeutic anticoagulation and was taken for a suction thrombectomy using the AngioVac (AngioDynamics, Latham, NY) aspiration thrombectomy device. The thrombectomy was successful and he was able to recover and was discharged from the hospital.
Conclusion:
Despite being a rare complication, IVC thrombosis can have detrimental effects. This case is an example of how IVC thrombus in the post-operative setting can lead to mortality. The gold standard is therapeutic anticoagulation but despite that, this patient continued to have worsening cardiogenic shock. Other therapies have been described but because of its rarity, they are only described in case reports. This case shows that the AngioVac device is a successful treatment option for IVC thrombus and can have the possibility of future use.
