Servier – Phlebolymphology

Novel large-bore aspiration thrombectomy (LBAT) systems are on the rise, with promising results, for use in patients with moderate high-risk or even in high-risk pulmonary embolism patients. AlphaVac F1885 (AngioDynamics Inc, Latham, New York) is a novel 18Fr 85o angled aspiration catheter based on the AngioVac platform but without the need for extracorporeal circuit. It has recently received a CE mark and we herein present our first case to describe its use in evacuating large pulmonary embolism thrombi.

A 58-year-old patient presented in the emergency department with shortness of breath and acute onset lower-extremity edema. Ultrasound Doppler revealed a recent deep venous thrombosis (DVT) in left lower extremity. Computed tomography pulmonary angiogram (CTPA) showed large bilateral pulmonary embolism in main branches. On exam, the patient presented hemodynamically stable with sats on 93% on low-flow oxygen. Laboratory testing revealed elevated troponin and pro– brain natriuretic peptide (proBNP). Cardiac echo showed right ventricular strain with right ventricle dilation (right to left ventricle ratio, RV/LV 1.4). The patient was categorized in moderate high-risk PE and admitted to ICU for observation without improvement on anticoagulation for the next 12 hours. We decided to intervene with a novel mechanical thrombectomy device (AlphaVac) due to immediate risk for deterioration.

Mechanical thrombectomy was performed under local anesthesia with mild sedation. Access was obtained using a 22Fr sheath. The AlphaVac catheter was used for aspiration in both pulmonary arteries retrieving large amounts of clot. The pulmonary artery pressures decreased from 85/27 mm Hg to 25/16 mm Hg on the table. Blood loss was 350cc. Procedure time: 25 min. The postoperative course was notable for complete symptom improvement and repeat echocardiogram showed an RV/LV ratio of 0.8.

This case highlights the efficacy and safety of AlphaVac in managing life-threatening pulmonary embolism (PE).