Removal of Caval and Right Atrial Thrombi and Masses Using the AngioVac Device: Initial Operative Experience.
OBJECTIVE
To describe initial single-center experience with a thrombectomy device in managing right atrial and caval thrombi, tumors, and vegetations.


METHODS
A retrospective analysis of AngioVac thrombectomy performed in 16 patients (mean age 53 y ± 13; 8 men, 8 women) between August 2013 and August 2015 was performed. Indications included right atrial mass/thrombus (6/16; 37.5%) and iliocaval thrombus (10/16; 62.5%). Procedural success was defined as aspiration of > 70% volume of atrial mass/thrombus or restoration of antegrade caval flow.


RESULTS
Procedural success was achieved in 4/6 (67%) right atrial masses/thrombi and 10/10 (100%) caval thrombi. All patients (8/8; 100%) with caval thrombus presenting with swelling/edema had improvement or resolution of symptoms. There were no procedural or periprocedural mortalities; complications included one major (6.3%; intraprocedural pulmonary embolus) and one minor (6.3%; access site hematoma not requiring transfusion) complication. Of 16 patients, 14 (87.5%) survived to discharge at a mean of 10 days ± 8 (range, 1-23 d), and 12 patients (75%) were alive at last known follow-up at a mean of 385 days ± 267 (range, 63-730 d). At a mean of 194 days ± 177 (range, 41-372 d), 4/16 (25%) patients were dead; no death was related to AngioVac thrombectomy. At a mean of 66 days ± 21 (range, 49-90 d) after intervention, 3/14 (21.4%) cases with procedural success had local recurrence of mass/thrombus.


CONCLUSIONS
AngioVac thrombectomy can be performed with high procedural success with clinical benefit in patients with right atrial and caval masses/thrombi.
Division of Interventional Radiology, Department of Radiology, University of California, Los Angeles, 757 Westwood Pl., Los Angeles, CA 90095.
John M
JM
Moriarty
Division of Interventional Radiology, Department of Radiology, University of California, Los Angeles, 757 Westwood Pl., Los Angeles, CA 90095.
Ramsey
R
Al-Hakim
Division of Interventional Radiology, Department of Radiology, University of California, Los Angeles, 757 Westwood Pl., Los Angeles, CA 90095.
Anshuman
A
Bansal
Division of Interventional Radiology, Department of Radiology, University of California, Los Angeles, 757 Westwood Pl., Los Angeles, CA 90095; Division of Interventional Radiology, Department of Radiology, West Los Angeles VA Medical Center, Los Angeles, California. Electronic address: jonathan.park09@gmail.com.
Jonathan K
JK
Park
D000328:Adult; D000368:Aged; D001706:Biopsy; D017548:Echocardiography, Transesophageal; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D006338:Heart Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D015141:Los Angeles; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D017131:Thrombectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*