Vacuum-assisted vegetation removal with percutaneous lead extraction: a systematic review of the literature

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.…”

“…However, a recent meta-analysis describes the limitations of the available data and the paucity of randomized comparisons of any lead extraction strategies for CIED infections. 5 Moreover, the data reported on percutaneous aspiration before lead extraction are heterogeneous, and poor outcomes are likely underreported. Additionally, patients are often sent to tertiary centers for this procedure and, as with our patient, transferred back postprocedurally, resulting in loss of rigorous follow-up.…”

Totally peripheral approach for ICD lead vegetation removal in a GUCH patient

“…1 In particular, the AngioVac system has demonstrated high success rate with a low complication for vegetation removal or debulking in PMrelated endocarditis with concurrent transvenous lead extraction (TLE). 2 Grown-up patients with congenital heart (GUCH) is an expanding population accounting for an annual increase of 5%. Sudden cardiac death occurs in nearly one-fourth of GUCH patients and implantable cardioverter defibrillators (ICDs) are recommended in selected cases.…”

“…The AngioVac system has been used in venous thromboembolic pathologies, in endocarditis on the tricuspid valve or right‐sided pacemaker (PM) wires, and in pulmonary thromboembolism 1 . In particular, the AngioVac system has demonstrated high success rate with a low complication for vegetation removal or debulking in PM‐related endocarditis with concurrent transvenous lead extraction (TLE) 2 …”

Use of vacuum-assisted aspiration for removal of vegetations during transvenous lead extraction

“…Numerous reports have demonstrated the use of the AngioVacÔ system (AngioDynamics Inc, Latham, NY) to debulk and remove vegetations and thrombi prior to and/or during TLE. 11 However, multiple concerns remain about the use of this system in a critically ill patient with high operative morbidities, including portability, vascular complications, size of cannulas for the system, need for system anticoagulation, difficulty steering the catheter, and cost of acquiring/maintaining the system. The IndigoÔ Thrombectomy System (Penumbra, Inc, Alameda, CA) is an aspiration catheter designed to engage the clot and extract it with a continuous vacuum pump.…”