Novel use of the AngioVac<sup>®</sup> system to remove thrombus during simultaneous extracorporeal membrane oxygenation life support

Griffith, Kendall C.; Jenkins, Eric; Copenhaver, William; Williams, David M.

doi:10.1177/0267659115589622

Cited by 14 publications

(8 citation statements)

References 7 publications

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“…2 In one case, the AngioVac device was used to evacuate thrombus associated with the venous cannula of an extracorporeal membrane oxygenation (ECMO) circuit, again with success. 3 The complete success rate, defined as removal of all thrombus, was 75% (n = 43), with an 11% (n = 6) partial success rate. In 14% (n = 8) of cases, minimal or no thrombus was retrieved.…”

Section: Resultsmentioning

confidence: 98%

“…In cases of catheter-related thrombus in patients with right to left shunts, as with a Fontan shunt, the AngioVac may be used prophylactically during catheter removal to prevent paradoxical PE. 3 Similarly, in the setting of inferior vena cava tumor thrombus, the AngioVac device may be used to prevent iatrogenic PE during surgical thrombectomy. 5 The AngioVac device can be used for thrombectomy of an ECMO cannula while maintaining ECMO flow.…”

Section: Discussionmentioning

confidence: 99%

“…5 The AngioVac device can be used for thrombectomy of an ECMO cannula while maintaining ECMO flow. 3 The AngioVac device has even been described for aortic thrombectomy (in an abstract at the 2015 Southern Association for Vascular Surgery). Further experience will allow for more innovative applications of the device.…”

Section: Discussionmentioning

confidence: 99%

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The Angiovac Device: Understanding the Failures on the Road to Success

Worku

Salemi

D’Ayala

et al. 2016

Innovations�(Phila)

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Objective Current percutaneous thromboembolectomy techniques may obviate surgical intervention in high-risk patients with iliocaval thrombus or thrombus of the right side of the heart, but typically require thrombus fragmentation and thrombolysis with associated bleeding and thromboembolic complications. The AngioVac (Angiodynamics, Latham, NY USA) device uses a percutaneous venovenous bypass circuit to aspirate intact thrombus. A review of the literature was performed with regard to the AngioVac device to determine the factors correlating with successful thrombus extraction. Methods A literature search was performed with regard to use of the AngioVac device using the PubMed database. A meta-analysis was not performed given the small size and lack of statistical analysis of the individual reports included. Results Twenty-three reports describing 57 procedures in 56 patients were analyzed. Indications for thrombectomy included iliocaval thrombus in 53% (30), thrombus of the right side of the heart, in 49% (28), pulmonary embolus in 14% (8), and upper extremity venous/Glenn shunt thrombosis in 7% (4). The complete success rate, defined as removal of all thrombus, was 75% (43), with an 11% (6) partial success rate. In 14% (8) of cases, minimal or no thrombus was retrieved. When analyzed by indication, iliocaval thrombus and thrombus of the right side of the heart demonstrated 87% (26) and 82% (23) complete success rates, respectively. Pulmonary embolus demonstrated a significantly lower success rate at 12.5% [1; (P < .001)]. Complications occurred in 12% (7), including six hematomas and one retroperitoneal bleed. Conclusions The AngioVac device offers an excellent alternative to surgical thrombectomy for patients presenting with iliocaval or intracardiac thrombus, with success rates of more than 80%, although it seems that pulmonary emboli are less amenable. Appropriate patient selection can lead to improved outcomes. Larger numbers are needed to make more definite conclusions.

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Section: Resultsmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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The Angiovac Device: Understanding the Failures on the Road to Success

Worku

Salemi

D’Ayala

et al. 2016

Innovations�(Phila)

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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%

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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“…At present, there is no report on the application of vascular interventional therapy. However, it has been reported that the AngioVac System can successfully evacuate the thrombus in cases of ECMO-related thrombosis [19].…”

Section: Discussionmentioning

confidence: 99%

Inferior vena cava thrombosis during extracorporeal membrane oxygenation: a case report and review of the literature

Chen

Liu

et al. 2021

J Med Case Reports

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Background Extracorporeal membrane oxygenation (ECMO) is an effective cardiopulmonary support therapy, which can provide temporary cardiopulmonary support for critically ill patients whose condition cannot be reversed by conventional therapy. However, there are many complications in the use of ECMO, such as bleeding, thrombosis, and so on. Among them, inferior vena cava (IVC) thrombosis which can cause pulmonary embolism is a rare complication, which may be life-threatening. Case presentation A 75-year-old female patient (Han Chinese ethnicity) with acute heart failure due to acute myocardial infarction in our department was retrospectively analyzed. After regular treatment was unsuccessful, she was treated with venoarterial ECMO (VA-ECMO). After her condition improved, she was withdrawn from ECMO and experienced a complication of IVC thrombosis. Enoxaparin was given immediately for 1 mg/kg every 12 hours hypodermic injection. The thrombus disappeared after anticoagulant therapy. She was discharged on the 60th day. Her level of consciousness returned to normal without residual central nervous system-related complications. Conclusions IVC thrombosis is one of the possible serious complications in the process of ECMO therapy. Prevention of thrombosis and optimization of the anticoagulant regimen are the main preventive measures. Anticoagulant therapy is still the main treatment of IVC thrombosis in the process of ECMO therapy. Other interventional strategies need to accumulate clinical experience.

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Novel use of the AngioVac^® system to remove thrombus during simultaneous extracorporeal membrane oxygenation life support

Cited by 14 publications

References 7 publications

The Angiovac Device: Understanding the Failures on the Road to Success

The Angiovac Device: Understanding the Failures on the Road to Success

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

Inferior vena cava thrombosis during extracorporeal membrane oxygenation: a case report and review of the literature

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Novel use of the AngioVac® system to remove thrombus during simultaneous extracorporeal membrane oxygenation life support

Cited by 14 publications

References 7 publications

The Angiovac Device: Understanding the Failures on the Road to Success

The Angiovac Device: Understanding the Failures on the Road to Success

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

Inferior vena cava thrombosis during extracorporeal membrane oxygenation: a case report and review of the literature

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Novel use of the AngioVac^® system to remove thrombus during simultaneous extracorporeal membrane oxygenation life support