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The AngioVac Device: Understanding the Failures on the Road to Success
Iosif Gulkarov1, Marcus D'Ayala2, Arash Salemi3, Robert J. Tranbaugh1, Regis Chang1, Berhane Worku1.
1Department of Cardiothoracic Surgery, New York Methodist Hospital, Brooklyn, NY, USA, 2Division of Vascular Surgery, New York Methodist Hospital, Brooklyn, NY, USA, 3Departmemt of Cardiothoracic Surgery, Weill Cornell Medical Center/New York Presbyterian Hospital, New York, NY, USA.
OBJECTIVE: Current percutaneous thromboembolectomy techniques may obviate surgical intervention in high risk patients with iliocaval or right heart thrombus, but typically require thrombus fragmentation and thrombolysis with associated bleeding and thromboembolic complications. The AngioVac (Angiodynamics, Latham, NY) device utilizes a percutaneous venovenous bypass circuit to aspirate intact thrombus. A review of the literature was performed with regards to the AngioVac device to determine the factors correlating with successful thrombus extraction.
METHODS: A literature search was performed with regards to use of the AngioVac device utilizing the Pubmed database.
RESULTS: Twenty-three reports describing 57 procedures in 56 patients were analyzed. Indications for thrombectomy included iliocaval thrombus in 53%(30), right heart thrombus 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 and right heart thrombus 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 over 80%, although it appears that pulmonary emboli are less amenable. Appropriate patient selection can lead to improved outcomes. Larger numbers are needed to make more definite conclusions.
| Iliocaval thrombosis | 53 (30) |
| Right heart thrombus | 49 (28) |
| Pulmonary embolus | 14 (8) |
| Upper extremity/Glenn shunt thrombosis | 7 (4) |
| Intracardiac foreign body | 30 (17) |
| Inferior vena cava filter | 21 (12) |
| Cancer | 37 (21) |
| Active infection | 19 (11) |
| Prothrombotic state | 11 (6) |
| Shock | 19 (11) |
| Complete success | 75 (43) |
| Partial success | 11 (6) |
| Uncuccessful | 14 (8) |
| Iliocaval | 87 (26) |
| Right heart thrombus | 82 (23) |
| Pulmonary embolus | 12.5 (1) |
| Cancer | 79 (11) |
| Active infection | 89 (8) |
| Prothrombotic state | 67 (2) |
| Complications | 12 (7) |
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