Germany forerunner of minimally invasive thrombosis removal procedure

A small incision in the groin, a special tube that is guided through the blood vessels towards the heart and a pump that sucks out (aspirates) the blood clot. That, in a nutshell, is the method used this month by the Bergmannsheil University Hospital of the Ruhr University Bochum in Germany.

Angiovac is the equivalent of a temporary bypass outside the body

The method, which is not new in itself, is called Angiovac. Normally, in the case of a patient who has a life-threatening risk of embolism (the dislodging of a blood clot in the bloodstream), they usually have to undergo extensive heart surgery, which involves opening up their chest.

Minimally invasive solution

The 73-year-old patient in Bochum who was treated with the angiovac procedure had previously had a defibrillator implanted, a special kind of pacemaker. The defibrillator comprises a battery and an electrode that is anchored in the right half of the heart and is intended to protect the patient from sudden cardiac arrest in the event of acute cardiac arrhythmia.

Because bacteria had infected the electrode of the patient, it led to a blood clot of about four centimeters in size forming on the electrode. The clot threatened to surge towards the lungs at any time and cause an embolism. Cardiac surgery was considered very drastic for the patient because of her overall poor health condition. Therefore, physicians suggested the new minimally invasive solution from Angiovac.

The angiovac system uses a cannula (tube) and what is known as the angiovac circuit, designed to drain fresh, soft blood clots or emboli in the veins. Angiovac is equivalent to a temporary bypass outside the body. Blood that is aspirated using the cannula is returned to the patient’s body thanks to the angiovac circuit so as to minimize blood loss.

1½ hour operation

In the case of the German patient, aspirating the blood clot took only a few minutes. A special catheter was aimed directly at the blood clot under the guidance of ultrasound. Support was provided by an ECMO, a device that temporarily supports the function of the lungs and heart. The cardiologists were then able to remove the implanted defibrillator from inside the chest along with the inflamed electrode under traction. The operation lasted an hour and a half.

Angiovac drainage systeem

The Angiovac drainage system that goes through blood vessels first came onto the market by the American company Angio Dynamics in 2012. The latest, third version was recently made available to cardiologists and was one of the first to be used by the Bochum University Clinic. The hospital is one of the largest in the Ruhr district. It owes its name (translated as “for the salvation of the miner“) to the fact that it was founded in 1890 as the world’s first clinic for treating injured miners.