Minimal-Invasive Aspiration Procedure Based on a Venovenous Extracorporeal Circuit for Removal of Thrombi or Vegetations

Objectives: We retrospectively evaluated the safety and efficacy of a novel minimal-invasive percutaneous aspiration procedure based on an extracorporeal circuit with an in-line filter in patients with central vein thrombi, right atrial thrombi, pulmonary embolism, and lead vegetations.

Methods: Between June 2015 and September 2018, we performed this percutaneous aspiration procedure in 61 patients (mean age 62.1 ± 16.1 years, 38 males, 23 females). Indications for this procedure were right atrial “in-transit” thrombi (n = 9; 14.7%), central vein thrombi (n = 5; 8.2%), cardiac implantable cardiovascular device infections with large lead vegetations (n = 43; 70.5%), pulmonary embolism (n = 2; 3.3%), and other vegetations (tricuspid valve, port catheter) (n = 2; 3.3%).

Results: Complete procedural success of the percutaneous aspiration procedure was achieved in 83.6%, and partial success was achieved in 9.8%. Venovenous configuration was femorofemoral in 85.2% (n = 52), right internal jugular–femoral in 13.1% (n = 8), and femoral-internal jugular in 1.7% (n = 1). No major complications related to the aspiration procedure occurred. A 30-day mortality was 1.7% (n = 1).

Conclusion: This novel aspiration procedure proved to be highly effective in different indications. It is performed minimal-invasively via percutaneous venous access and comes with a low complication rate.