Novel Use of AngioVac System to Prevent Pulmonary Embolism during Radical Nephrectomy with Inferior Vena Cava Thrombectomy

Brown, R. James; Uhlman, Matthew A.; Fernandez, Joss D.; Collins, Thomas E.; Brown, James A.

doi:10.1159/000343550

Cited by 17 publications

(8 citation statements)

References 9 publications

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“…9 Given the lack of evidence-based management options and the high-risk nature of these patients, there has been increasing use of the percutaneous vacuum-based suction device, AngioVac (Angio-Dymamics, Latham, NY), to manage right-sided endocarditis and central thrombus. [10][11][12][13][14][15][16][17][18] Data regarding the AngioVac procedure is limited. 19 The purpose of this study was to review a large single center series of patients treated with the AngioVac procedure.…”

Section: Introductionmentioning

confidence: 99%

Vacuum‐assisted extraction of ilio‐caval and right heart masses: A 5‐year single center experience

Newman¹,

Patel

Keeling

et al. 2020

J Card Surg

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Purpose Despite paucity of data, there exists growing popularity of catheter‐based extraction methods for intravascular thrombi and vegetations. We describe a large single center experience with vacuum‐assisted extraction techniques (VAET) for right‐sided intravascular and cardiac masses. Methods We retrospectively reviewed the perioperative course of patients undergoing VAET between 2014 and 2019. Primary outcomes were survival and freedom from recurrent bacteremia. Procedural success was a composite definition of survival, majority of mass extraction, absence of recurrent bacteremia, and valve function not requiring further intervention during index hospitalization. Results Of the entire cohort (n = 58), 48% and 52% underwent VAET for vegetations and sterile thrombi, respectively. Of those with positive cultures, the most common organism isolated was Staphylococcus aureus (48%). Preoperative active bacteremia was present in 36% (21/58) and of these patients, 76% (16/21) had neither recurrent nor persistent bacteremia post‐op. The majority of masses (67%, 38/58) were debulked with an average reduction in size of 42%. Conversion to open surgery occurred in 3.5% (2/58). Intraoperative and 30‐day survival were 98% (57/58) and 90% (28/31), respectively. Overall success was 86% (50/58). The prevalence of moderate/severe tricuspid regurgitation was 37% pre‐op and 61% post‐op. Average length of intensive care unit and overall hospital stay was 5.6 and 16 days, respectively. Conclusions In this single center experience, VAET was conducted safely with a high degree of success and freedom from short‐term recurrent bacteremia. This minimally invasive procedure is an attractive alternative to traditional open techniques for removal of right‐sided intravascular and cardiac masses.

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Section: Introductionmentioning

confidence: 99%

Vacuum‐assisted extraction of ilio‐caval and right heart masses: A 5‐year single center experience

Newman¹,

Patel

Keeling

et al. 2020

J Card Surg

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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%

“…Over the past few years, AngioVac has been utilized as an extracorporeal alternative to traditional invasive techniques for treating venous thrombi and endocardial vegetations. The device has been used for the treatment of iliocaval thrombi, PE, right atrial/caval thrombi, prevention of paradoxic thrombi, and debulking of implantable device vegetation …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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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“…(I) The large profile of the device prevents its passage into smaller veins e.g., leg veins; (II) Rigidity of the current 22-French device and lack of maneuverability cause difficulty to manipulate around tight curves (e.g., right ventricular outflow tract) which makes intracardiac and pulmonary artery masses harder to extract in comparison to IVC masses. Conversion to open embolectomy may still be needed even with additional techniques that may help to overcome this limitation; (III) The time requirement for device setup and additional personnel requirement currently limit its use in emergencies; (IV) The filter is not designed to eliminate bacteria; which carries a concern when the extracted mass is not sterile, e.g., vegetation; (V) Cost is remarkably higher than thrombolytic therapy (2,5,9,10); (VI) Patients with contraindications to systemic heparinization would not be eligible for AngioVac (9,10). In conclusion, AgioVac aspiration device can be an effective and safe option for removal of undesirable intravenous masses to avoid surgery and/or when other traditional treatment options are considered unsuitable.…”

Section: Discussionmentioning

confidence: 99%

Non-surgical extraction of right atrial mass by AngioVac aspiration device under fluoroscopic and transesophageal echocardiographic guidance

Enezate

Kumar

Aggarwal

et al. 2017

Cardiovasc. Diagn. Ther.

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Right-sided cardiac masses are commonly encountered. We present a challenging case of a right atrial thrombus in a patient who had a high surgical risk for open removal. AngioVac aspiration device, under transesophageal echocardiography (TEE) and fluoroscopy guidance, was successfully used to remove the thrombus. The patient tolerated the procedure well and was discharged home. Our case confirms the safety and efficacy of this procedure for treatment of unwanted intracardiac and intravascular masses in patients who are not candidates for conventional therapies of surgery or thrombolytics.

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Novel Use of AngioVac System to Prevent Pulmonary Embolism during Radical Nephrectomy with Inferior Vena Cava Thrombectomy

Cited by 17 publications

References 9 publications

Vacuum‐assisted extraction of ilio‐caval and right heart masses: A 5‐year single center experience

Vacuum‐assisted extraction of ilio‐caval and right heart masses: A 5‐year single center experience

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

Non-surgical extraction of right atrial mass by AngioVac aspiration device under fluoroscopic and transesophageal echocardiographic guidance

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