Implementation und Pitfalls des perkutanen Aspirationssystems AngioVac

In recent years the percutaneous aspiration system (PAS) AngioVac (AngioDynamics, Latham, NY, USA) has emerged into a very promising alternative to conventional cardiac surgery interventions for the removal of thrombi from the right heart chambers. It can also be used in the treatment of pulmonary embolism, the removal of lead vegetations in transvenous lead extraction procedures in infections of cardiac implantable electronic devices and in special cases for aspiration of vegetation in tricuspid valve endocarditis. The indications and the assessment of the efficacy are so far based predominantly on a few studies and expert opinions, which underlines the necessity for further studies.

The PAS is a minimally invasive procedure for removal of thrombi and vegetations from the right heart. With the aid of a closed extracorporeal circulation thrombi and vegetation are aspirated, whereby a 170µm filter in the extracorporeal perfusion system retains solid material. The access for the aspiration cannula is carried out via a 26F sheath, which is introduced either in the right femoral vein or the right internal jugular vein. The 22F aspiration cannula has a funnel-shaped tip, which can suck thrombi up either completely or in fragmented pieces. A 16F or 18F cannula is used for the venous return flow.

In published studies on the PAS procedural success rates of 73.6–96% have been reported, whereby the risk of severe complications was low.

The PAS represents an effective and safe alternative minimal-invasive treatment option to conventional cardiac surgery interventions for thrombi and vegetation in the right heart.