title: Thrombectomy using suction filtration and veno-venous bypass: single center experience with a novel device.
abstract: OBJECTIVE
  To describe the first single center experience with a novel aspiration thrombectomy device.
  
  
  BACKGROUND
  The appearance of inferior vena cava or right-sided intracardiac thrombus may prompt consideration of percutaneous thrombectomy as a method to prevent new or worsening pulmonary embolism (PE). The AngioVac is a novel thrombectomy device composed of a cannula and extracorporeal circuit with filter for pump-assisted removal of intravascular debris which is coupled with a reinfusion catheter for return of blood to the patient. The device has been approved by the United States Food and Drug Administration since 2009. This report represents the first significant case series describing its use, feasibility and outcomes in evacuating large caval thrombi or intracardiac masses in PE.
  
  
  METHODS
  This is a retrospective analysis of patient and case characteristics and in-hospital clinical outcomes of AngioVac thrombectomy in 14 consecutive patients treated between April 2010 and July 2013 at our institution.
  
  
  RESULTS
  Fourteen consecutive patients (mean age 50, 64% female) underwent 15 AngioVac procedures over 40 months. Indications included intracardiac mass (73%), acute PE (33%), and caval thrombus (73%). Four patients (27%) were in shock at the start of the procedure. Peri-procedure mortality was 0% and in-hospital mortality was 13% at a mean follow-up of 23 days. There were no pulmonary hemorrhages, strokes or myocardial infarctions. Though 73% had a post procedural drop in hematocrit, only two bleeding events were related to access site and required a transfusion.
  
  
  CONCLUSIONS
  AngioVac thrombectomy is feasible in critically ill patients with acute DVT or PE and large caval thrombi or intracardiac masses.
authors: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Cameron W
authors: CW
authors: Donaldson
authors: Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Joshua N
authors: JN
authors: Baker
authors: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Rajeev L
authors: RL
authors: Narayan
authors: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Tim S
authors: TS
authors: Provias
authors: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Andrew N
authors: AN
authors: Rassi
authors: Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
authors: Jay S
authors: JS
authors: Giri
authors: Cardiovascular Medicine/Intervention and Structural Heart Disease, Wellmont CVA Heart Institute, Kingsport, Tennessee.
authors: Rahul
authors: R
authors: Sakhuja
authors: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Ido
authors: I
authors: Weinberg
authors: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Michael R
authors: MR
authors: Jaff
authors: Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Kenneth
authors: K
authors: Rosenfield
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston; D002406:Catheterization, Peripheral / Q000009:adverse effects; D004867:Equipment Design; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013396:Suction; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D013927:Thrombosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*
keywords: deep venous thrombosis; peripheral venous catheterization; pulmonary embolism; thrombectomy