The role of percutaneous vacuum-assisted thrombectomy for intracardiac and intravascular pathology

Abstract

Vacuum-assisted thrombectomy (VAT) is a mechanical suction device that can be deployed to aspirate thrombi in the heart and vascular system. Successful percutaneous aspiration of iliocaval, right heart, and pulmonary arterial thrombi have been reported, in addition to the debulking of intravascular and intracardiac masses and vegetations. VAT is indicated for patients who are poor surgical candidates and/or have a contraindication to thrombolysis. This review discusses the mechanism, current results, potential clinical indications, and limitations of VAT for iliocaval and intracardiac mass removal.

Use of a clot aspiration system during transvenous lead extraction

“…It then utilizes a bypass circuit in which blood is pumped through a circuit containing a filter to trap the debris. The blood is then returned via a second large‐bore cannula 4,5 . Limitations of this system are the suction cannula does not have a steering mechanism (though this is likely to change with future generation devices), it requires the availability of a bypass circuit, it requires two large‐bore venous access sites, and the patient must be fully anticoagulated while thrombectomy is performed.…”

“…Use of percutaneous methods, specifically the Angiovac device, to debulk lead associated thrombi or vegetations before extraction has been previously described. [4][5][6][7][8] However, this system requires the availability of a cardiopulmonary bypass circuit, therapeutic anticoagulation, superior (internal jugular) vascular access, and can be difficult to implement ad-hoc.…”

“…The blood is then returned via a second large-bore cannula. 4,5 Limitations of this system are the suction cannula does not have a steering mechanism (though this is likely to change with future generation devices), it requires the availability of a bypass circuit, it requires two large-bore venous access sites, and the patient must be fully anticoagulated while thrombectomy is performed. The potential advantages of this system in comparison to Penumbra are its ability to aspirate large thrombi and possibly reduced potential for embolization of small pieces of debris during attempted aspiration.…”

“…However, open extraction is associated with significantly greater morbidity compared with transvenous extraction, particularly when via a midline sternotomy approach. Use of percutaneous methods, specifically the Angiovac device, to debulk lead associated thrombi or vegetations before extraction has been previously described 4–8 . However, this system requires the availability of a cardiopulmonary bypass circuit, therapeutic anticoagulation, superior (internal jugular) vascular access, and can be difficult to implement ad‐hoc.…”

Saved by the VAC: Minimally Invasive Removal of a Surely Fatal Right Heart Thrombus in a Patient with Advanced Heart Failure

“…Percutaneous aspiration thrombectomy represents a novel and less invasive method to address right heart thrombi in select patients. This treatment innovation has previously been utilized for aspiration of DVTs, including thrombi associated with inferior vena cava filters, as well as vegetations, tumors, and foreign bodies [10,11]. The AngioVac system essentially functions as a venovenous extracorporeal membrane oxygenation circuit connected to a thrombus filter and centrifugal pump.…”