Rapid Response Protocol for Large-Bore Access Thrombosis After Percutaneous LVAD Removal

Vascular thrombosis after large-bore device removal is a rare but critical complication that can result in limb ischemia or the need for open surgical intervention. Rapid identification and endovascular management are key to improving patient outcomes.

With the 2025 American Heart Association/American College of Cardiology guidelines assigning a Class IIa recommendation for mechanical circulatory support in patients experiencing ST-segment elevation myocardial infarction with cardiogenic shock, the use of percutaneous left ventricular assist devices is increasing. However, protocols for safe closure after removal remain limited, prompting the need for structured quality improvement process managing.

A patient required support from a percutaneous left ventricular assist device for 5 days. During removal, angiography revealed extensive iliac artery thrombosis. Multidisciplinary response included contralateral imaging, mechanical thrombectomy with dedicated large-vessel system, and subsequent closure with a collagen-based vascular closure device.

Routine angiography after large-bore device removal enables early complication detection. Mechanical thrombectomy provides an effective, minimally invasive option to avoid surgical escalation.