AngioVac extraction of intra-atrial hepatoma masquerading as PICC-associated thrombus

Background AngioVac is a new device for filtering intravascular thrombi and emboli. Publications on the device are limited and underpowered to objectively estimate its safety and efficacy. We aimed to overcome this by performing a meta‐analysis on the results of AngioVac for treating venous thromboses and endocardial vegetations. Methods A systematic literature review was performed to identify all articles reporting cardiac vegetation and/or thrombosis extraction using AngioVac. Endpoints were successful removal, operative mortality, conversion to open surgery, hospital stay, recurrent thromboembolism, and follow‐up mortality. Random effect model was used, and pooled event rates (PERs) and incidence rate (IR) were calculated. Results A total of 42 studies with 182 patients (81 vegetation and 101 thrombosis) were included. Overall mean follow‐up times were 3.1 and 0.7 years in vegetation and thrombosis patients, respectively. The PERs for successful removal were 74.5 (confidence interval [CI]: 48.2‐90.2), 80.5 (CI: 70.0‐88.0), and 32.4 (CI: 17.0‐52.8) in vegetation, right atrial/caval venous thrombi, and pulmonary emboli (PE) patients, respectively. The PERs for operative mortalities were 14.6 (CI: 7.7‐25.8), 14.8 (CI: 8.5‐24.5), and 32.3 (CI: 15.1‐56.3), respectively. The PERs for conversion to open surgery were 25.0 (CI: 9.3‐51.9) and 12.3 (CI: 5.4‐25.6) in vegetation and thrombosis patients, respectively. The IR of recurrent thromboembolism was 0.18 per person per year (PPY) (CI: 0.00‐14.69) in vegetation and 0.19 PPY (CI: 0.08‐0.48) in thrombosis patients. IR of follow‐up mortality was 0.37 PPY (CI: 0.11‐1.21) in thrombosis patients. Conclusions AngioVac is a viable option for extracting right‐sided vegetations and right atrial/caval venous thrombi. Rates of successful extraction and mortality are significantly worse for PE.

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“…Out of 53 retrieved searched articles, 42 met our inclusion criteria. The PRISMA flowchart is shown in Figure S1.…”

Section: Resultsmentioning

confidence: 99%

“…To date, the literature on AngioVac is fairly limited . The published studies have all been from single institutions, with limited sample sizes and/or varied indications, such that an objective estimate of the safety and efficacy of this device for each individual indication is not possible at present.…”

Section: Introductionmentioning

confidence: 99%

AngioVac for extraction of venous thromboses and endocardial vegetations: A meta‐analysis

et al. 2019

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“…Prior cases of percutaneous debulking of tumor-thrombus using the AngioVac system have been reported with variable success. [3][4][5] Our case illustrates the feasibility and technical aspects of this approach for gradual debulking of a very large right atrial tumor without a thrombotic component using this system. High vacuum pressures can be obtained with this system.…”

mentioning

confidence: 87%

Percutaneous Debulking of a Large Right Atrial Tumor

El‐Sabawi

Mohadjer

Holiday

et al. 2022

Journal of the Society for Cardiovascular Angiography & Int

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“…A 70-year-old man had a history of cirrhosis complicated by hepatocellular carcinoma with metastases to the ribs (12). He presented to the hospital with acute-on- chronic back pain and weakness and was found to have a large psoas abscess and epidural/subdural collections.…”

Section: Casementioning

confidence: 99%

“…After manipulation with the balloon, TEE revealed successful removal of the atrial mass. The specimen was sent for pathologic analysis and found to be neoplastic tissue consistent with hepatocellular carcinoma (gross and histologic preparations of aspirate are depicted in the article by Abboud et al [12]). The patient was discharged with scheduled oncologic follow-up but did not return.…”

Section: Casementioning

confidence: 99%

Single-Center Experience Using AngioVac with Extracorporeal Bypass for Mechanical Thrombectomy of Atrial and Central Vein Thrombi

Resnick

O’Brien

Strain

et al. 2016

Journal of Vascular and Interventional Radiology

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AngioVac extraction of intra-atrial hepatoma masquerading as PICC-associated thrombus

Cited by 11 publications

References 8 publications

AngioVac for extraction of venous thromboses and endocardial vegetations: A meta‐analysis

AngioVac for extraction of venous thromboses and endocardial vegetations: A meta‐analysis

Percutaneous Debulking of a Large Right Atrial Tumor

Single-Center Experience Using AngioVac with Extracorporeal Bypass for Mechanical Thrombectomy of Atrial and Central Vein Thrombi

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