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CardioVascular and Interventional Radiology

, Volume 38, Issue 4, pp 1021–1024 | Cite as

A Novel Technique for Endovascular Removal of Large Volume Right Atrial Tumor Thrombus

  • Barbara Nickel
  • Timothy McClure
  • John Moriarty
Case Report

Abstract

Venous thromboembolic disease is a significant cause of morbidity and mortality, particularly in the setting of large volume pulmonary embolism. Thrombolytic therapy has been shown to be a successful treatment modality; however, its use somewhat limited due to the risk of hemorrhage and potential for distal embolization in the setting of large mobile thrombi. In patients where either thrombolysis is contraindicated or unsuccessful, and conventional therapies prove inadequate, surgical thrombectomy may be considered. We present a case of percutaneous endovascular extraction of a large mobile mass extending from the inferior vena cava into the right atrium using the Angiovac device, a venovenous bypass system designed for high-volume aspiration of undesired endovascular material. Standard endovascular methods for removal of cancer-associated thrombus, such as catheter-directed lysis, maceration, and exclusion, may prove inadequate in the setting of underlying tumor thrombus. Where conventional endovascular methods either fail or are unsuitable, endovascular thrombectomy with the Angiovac device may be a useful and safe minimally invasive alternative to open resection.

Keywords

Experimental IR Interventional Oncology Aspiration Thrombectomy Vena Cava Heart/Cardiac Cancer 

Notes

Conflict of interest

Barbara Nickel, Timothy McClure and John Moriarty have no conflict of interest.

Informed consent

For this type of study, formal consent is not required.

References

  1. 1.
    Rose PS, Punjabi NM, Pearse DB (2002) Treatment of right heart thromboemboli. Chest 121:806–814PubMedCrossRefGoogle Scholar
  2. 2.
    Starkey IR, de Bono DP (1982) Echocardiographic identification of right-sided cardiac intracavitary thromboembolus in massive pulmonary embolism. Circulation 66:1322–1325PubMedCrossRefGoogle Scholar
  3. 3.
    Dudiy Y, Kronzon I, Cohen H et al (2012) Vacuum thrombectomy of large right atrial thrombus. Catheter Cardiovasc Interv 79(2):344–347PubMedCrossRefGoogle Scholar
  4. 4.
    Wunderlich N, Franke J, Sievert H (2013) A novel technique to remove a right atrial thrombotic mass attached to a patent foramen ovale closure device. Catheter Cardiovasc Interv. doi: 10.1002/ccd.24972 Google Scholar
  5. 5.
    Todoran TM, Sobieszczyk PS, Levy MS et al (2011) Percutaneous extraction of right atrial mass using the Angiovac aspiration system. J Vasc Interv Radiol 22(9):1345–1347PubMedCrossRefGoogle Scholar
  6. 6.
    Divekar AA, Scholz T, Fernandez JD (2013) Novel percutaneous transcatheter intervention for refractory active endocarditis as a bridge to surgery-Angiovac aspiration system. Catheter Cardiovasc Interv 81(6):1008–1012PubMedCrossRefGoogle Scholar
  7. 7.
    Sakhuja R, Gandhi S, Rogers RK et al (2011) A novel endovenous approach for treatment of massive central venous or pulmonary arterial thrombus, mass, or vegetation: the AngioVac suction cannula and circuit. J Am Coll Cardiol 57:1535CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2014

Authors and Affiliations

  • Barbara Nickel
    • 1
    • 2
  • Timothy McClure
    • 2
  • John Moriarty
    • 2
  1. 1.US Teleradiology and Quantum Medical Radiology GroupPalm SpringsUSA
  2. 2.Department of Interventional RadiologyUCLA Medical CenterLos AngelesUSA

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