Use of a clot aspiration system during transvenous lead extraction

Abstract

Introduction The optimal approach to the extraction of leads with large vegetations remains uncertain. Methods High‐risk patients with lead associated vegetations undergoing device extraction at Vanderbilt Hospital with concomitant use of the Penumbra Aspiration System (Penumbra Inc, Alameda, CA) are described. An 8.5 Fr Agilis NXT (Abbott Inc, St. Paul, MN) was advanced to the right atrium, through which a Penumbra Indigo Cat‐8 catheter was advanced. Using intracardiac echocardiography, the Penumbra was positioned directly on the vegetation, suction was applied until adherent, and the Indigo catheter and Agilis sheath were then removed en‐bloc and aspirated debris flushed out. This was repeated until debulking was considered successful. Results Eight cases were performed. The median vegetation size was 2 cm. Pathogens were Enterococcus, Staphylococcus, Candida, Cutibacterium, and Enterobacter. In seven of eight cases, aspiration successfully reduced vegetations to less than 1 cm before successful percutaneous cardiac implantable electronic device removal. One patient underwent surgical removal via thoracotomy. There were no acute complications related to the Penumbra catheter. Three patients had CT evidence of small pulmonary emboli postprocedure. The length of stay was 3 to 27 days. One patient died on POD 1 of refractory ventricular tachycardia unrelated to the procedure. One patient died of ongoing sepsis 2 weeks postextraction. Conclusions The Penumbra Indigo Aspiration system can be useful for vegetation debulking before transvenous lead extraction.

Percutaneous Lead Extraction in Patients with Large Vegetations: Limiting our Aspirations

“…11 Vegetation removal prior to TLE has thus represented an appealing therapeutic option with reports of successful percutaneous aspiration prior to TLE showing promising results, albeit with unknown long-term benefit. 12,13 Although the lack of new PEs after TLE in this report does not directly support the effort, cost, and added risk of such a strategy, "debulking" of infectious burden remains a tempting complementary treatment. Importantly, the acute safety of TLE with large vegetations in this study should not be extrapolated to chronic, large lead-related masses, which are more like to cause acute PE if embolized.…”

Vacuum-Implemented Removal of Lead Vegetations in Cardiac Device-Related Infective Endocarditis

“…Successful removal rates vary depending on the specific origin and location of the mass, ranging between 60 and 80% in larger registries and series [ 16 , 31 ]. However, when considering CDRIE vegetations debulking, procedural success is >90% in most of published reports [ 7 , 11 , 12 , 13 , 32 ]. In a recent multi-center cohort including 101 patients, Starck et al proved a percutaneous vacuum-assisted aspiration to be completely successful in 94% of CDRIE [ 13 ], similarly to conventional TLE procedures [ 33 ].…”

“…The AngioVac system (AngioDynamics, Latham, NY, USA) is a novel percutaneous technology that includes an aspiration cannula combined with a filter, a centrifugal pump, and a venous or arterial reinfusion cannula, intended for the intravascular aspiration of right-sided masses. This device has found an application for CDRIE vegetations debulking before lead extraction [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. A systematic review of literature by Rusia et al in 2019 collected a total of 88 patients in whom this device has been successfully adopted to treat CDRIE in 97.7% of cases [ 15 ].…”

TEE-Guided Percutaneous Aspiration of a Large Lead-Associated Vegetation Prior to Transvenous Lead Extraction

“…1 A potential advancement in this area is the novel use of vacuum-assisted aspiration devices to remove or significantly debulk lead-associated vegetations before percutaneous extraction. [3][4][5][6] This new management option is especially appealing in light of the increasing need for lead extractions in older patients and those with more comorbidities, who may not tolerate surgical management. 7 Although there is a number of available percutaneous devices that can remove intravascular or intracardiac thrombus, vegetations, or masses, the AngioVac system has a large inflow cannula that was well suited to handle the sizable vegetation encountered in this case.…”