case_images: PMC11160386_01
case_images: During 2-dimensional transesophageal echocardiography (TEE), a mass was observed in the right atrium and later identified as a large mass measuring 7 x 3.0 cm, with the body measuring 3.5 x 3.0 cm and the stalk measuring 3.5 x 1.0 cm; it originated in the superior vena cava and occupied significant space in the right atrium. Intraoperatively, attempts were made to extract the mass using the AngioVac cannula, but its size and chronicity posed challenges despite multiple high-flow suction attempts. Subsequently, the FlowTriever 2 was utilized alongside active suction from the AngioVac to break up the mass while efforts were made to extract it. A mesh disc was employed to prevent embolization during the procedure. Although the main body of the mass was successfully extracted, a sizable peduncle/stalk remained attached to the superior vena cava, necessitating the use of a snare to cut the base of the mass. Ultimately, the mass, along with its stalk, was completely extracted through the AngioVac, resulting in the resolution of the mass with no residual fragments remaining; see also at https://youtu.be/0fA2d-mKOK0.
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case_images: PMC11160386_01_.jpg
case_images: V1
case_images: Next, through the right internal jugular vein, a 24F Inari FlowTriever sheath was advanced to the superior vena cava where the mass originated (Figure 1A). Next, while the AngioVac catheter was actively catching the mass, the FlowTriever toolkit (the FlowTriever 2 disc, Figure 1B) was used to break up the mass while performing active suction to help push it into the AngioVac cannula (Video 1). To prevent embolization of the detached piece through the right internal jugular (RIJ) FlowTriever sheath, we advanced the FlowTriever catheter (the three nitinol mesh discs) from the RIJ and deployed one disc at the inferior vena cava/right atrial (IVC/RA) junction to prevent migration of the clot upwards to the pulmonary artery while also trying to get the piece into the 26F Gore DrySeal sheath (Figure 1C, Video 1).
case_images: A cine showing the use of the two devices: (A) Inari FlowTriever sheath in the right internal jugular vein and the AngioVac from the femoral approach. (B) FlowTriever 2 disc. (C) FlowTriever catheter's nitinol mesh disc to prevent clot migration, while the AngioVac catheter is being removed with a mass attached.
case_images: mdcvj-20-1-1376-g1.jpg
case_images: PMC11160386_01_mdcvj-20-1-1376-g1.jpg
case_images: F1
case_images: Figure 2 shows the gross appearance of the mass after successful fragmentation and extraction.