Key result
Percutaneous vacuum-assisted thrombectomy successfully clears extensive tumor thrombus, rapidly resolving acute right heart strain.
Case Report (n=1)
No
Percutaneous aspiration thrombectomy using the AngioVac and Penumbra systems is feasible and can be clinically successful for managing right heart and pulmonary tumor thrombi in patients contraindicated for thrombolysis or surgical resection.
May offer nonsurgical option for tumor thrombus when surgery contraindicated; hypothesis-generating case report leaving broader safety and efficacy open.
A 19-year-old female presented with a 2-month history of abdominal discomfort and palpable abdominal mass; a computer tomography scan revealed a large retroperitoneal mass as well as high suspicion of thrombus in her inferior vena cava. Right kidney core biopsy showed diagnostic features of synovial sarcoma. While awaiting workup for her mass she was placed on anticoagulants. However, she re-presented to hospital 3 weeks later complaining of 3 days of shortness of breath. A repeat computer tomography scan revealed extensive thrombus burden with tumor thrombus involving the inferior vena cava, a large right atrial intracardiac thrombus, multiple segmental right pulmonary emboli, and a large embolus causing total occlusion of the left main pulmonary artery with findings suggestive of associated lung infarction. The patient's disease was not amenable to surgical resection and thrombolytic therapy was contraindicated due to associated intratumor hemorrhage, thus prompting consideration of thrombectomy under emergency approval from Health Canada. The patient underwent an overall successful total aspiration thrombectomy of the intracardiac tumor thrombus with subsequent resolution of her right heart strain, using the extracorporeal AngioVac aspiration system and partial aspiration of the extensive pulmonary emboli using the Penumbra Indigo Lightning 12 system. She was transferred to the intensive care unit and extubated 2 days later and was discharged from hospital shortly after without supplemental oxygen.
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Jafri et al. (2025) conducted a case report in Synovial sarcoma with intracardiac and pulmonary tumor thrombus (n=1). Percutaneous vacuum-assisted tumor thrombectomy (AngioVac and Penumbra Lightning 12) was evaluated on Successful thrombus aspiration and clinical improvement. Percutaneous vacuum-assisted thrombectomy successfully removed extensive intracardiac and pulmonary tumor thrombus in a patient with synovial sarcoma, resolving right heart strain.
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