A 35-year-old morbidly obese woman with a history of deep vein thrombosis and pulmonary embolism presented for right atrial thrombectomy via AngioVac suction system. A portion of the thrombus could not be suctioned into the AngioVac cannula, leading to fragmentation and distal embolization with hemodynamic collapse. This sequence, observed in real time under transesophageal echocardiography, also demonstrated that the clot had echocardiographic features of chronicity. A well-organized chronic clot may be more difficult to extract via this method, leading to the complication described. With increasing popularity of this less invasive method, further investigation to understand the indications and contraindications is warranted.
From the Department of Anesthesiology and Perioperative Medicine, Augusta University, Augusta, Georgia.
Accepted for publication November 2, 2016.
Funding: Department of Anesthesiology and Perioperative Medicine, Augusta University.
The authors declare no conflicts of interest.
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Address correspondence to Shvetank Agarwal, MD, FASE, Department of Anesthesiology and Perioperative Medicine, Augusta University, 1120 15th St, BIW-2144, Augusta, GA 30912. Address e-mail to firstname.lastname@example.org.