Use of AngioVac device in debulking endocarditis vegetations before lead extractions

Background Systemic infection of cardiac implantable electronic devices (CIEDs) usually manifests as endocarditis, with vegetations involving the lead and cardiac valves. Cardiac implantable electronic device systemic infections involve the transvenous or epicardial portion of the lead in addition to adjacent endocardium. History, blood cultures, and imaging are the cornerstone of diagnosis. The treatment of CIED infections involves intravenous antibiotics, complete removal of the CIED, and reimplantation after clearance of bacteraemia. AngioVac is used for the removal of right atrial masses, right atrial thrombi, and right-sided endocarditis vegetations. It can provide a mechanism for debulking of lead vegetations prior to their removal. Case summary We describe a case series of five patients who underwent debulking of lead vegetations with AngioVac prior to cardiac implantable electronic device removal. Four of our patients had defibrillators implanted for ventricular tachycardia. Three patients had involvement of the right atrial lead. Staphylococcus aureus was the most common organism involved. All patients had successful debulking of lead vegetations without any intraprocedural complications or 30-day mortality. Discussion Traditionally, large vegetations (>2 cm) involving the CIED apparatus required open surgery before device removal but more recently, AngioVac device has been used for the removal of vegetations from intracardiac leads before their removal, offering an alternative to the traditional surgical approach for high or prohibitive risk patients. Our case series adds to the growing body of evidence supporting the use of AngioVac in debulking leads prior to their removal.